Q Manage Health Care Vol. 23, No. 2, pp. 94–98 C 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Implementing Incentivized Practice to Improve Patient Care in Developing Countries Zia Mohiuddin, MS; Laura Rosemary Sanchez, MD, MBA; Jose Manuel Alcantra, MD; Waqas Shuaib, MD Introduction: Faculty awards provide an incentive to encourage higher standards of personal performance, which closely reflects the quality of health care. We report the development and implementation of the first medical faculty award program in the region. Material and Methods: Anonymous preaward survey evaluated responses to understand the overall state of our institution. Five awards were celebrated. An anonymous postaward survey gathered responses to evaluate the effectiveness of the program. Results: A total of 60% (307/509) of preaward survey responses were collected. Among those, 92% (283/307) felt that employee recognition was important and 78% (240/307) felt that performance should be the deciding criteria for employee recognition. A 24% (20/85) of the faculty received the decade of excellence award and 13% (11/85) received the compassionate physician award. Best service award was granted to 7% (6/85) of the nominees. Postaward survey showed 68% (170/250) agreed that the award ceremony incentivized them to increase quality of personal performance. Conclusion: In summary, we feel that this transparent, objective, and peer-nominated awards program could serve as an incentivized model for health care providers to elevate the standards of personal performance, which in turn will benefit the advancement of patient care.
Key words: awards, health care, incentivized practice, patient care
I
mprovement in the quality of health care in developing countries has been subtle mostly due to a lack of organizational leadership and financial resources. In light of recent literature, health administrators are taking notice of the negative impact a dissatisfied faculty has on patient care.1 The globally felt 2008 financial crisis lead to a significant downsizing and as a result compromised employee loyalty and commitment. The traditional pay-for-performance methodology has proven to be a valuable asset in incentivizing employees throughout the years. However, in these uncertain financial times, health care managers are seeking other ways to enhance productivity. Medical practices throughout the United States are rapidly becoming evidence-based practices with strong interest in quality management of health care. With higher competition and tighter budgets, quality management is now gaining popularity across borders as management teams are challenged to sustain
Author Affiliations: Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic (Drs Mohiuddin, Sanchez, Alcantra, and Shuaib). Correspondence: Waqas Shuaib, MD, Hospital General de la Plaza de la Salud, Ave. Ortega y Gasset, La Fe, Santo Domingo, Republica Dominicana (Waqas1184@ ´ hotmail.com) The authors thank Luisa J. Polanco for her feedback on the details of the awards timeline and Mario C. Vega for providing missing statistics. Authors Z.M., L.R.S., and J.M.A. designed the survey. W.S. provided statistical support. L.R.S. is the chair of the awards committee and conceived the idea of the manuscript. Z.M. and W.S. wrote the first and the final draft. W.S. takes responsibility for the paper as a whole. There are no financial, consultant, institutional, or other relationships that might lead to bias or a conflict of interest. DOI: 10.1097/QMH.0000000000000027
94 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Incentivized Practice to Improve Patient Care
and offer high-quality medical care. Previous literature shows medical employees’ dissatisfaction may be related to chairman/leadership discontent, lack of recognition in teaching and clinical excellence, and professional advancement issues.2,3 While the option of releasing dissatisfied faculty may seem to be the easy way out, cost of replacing medical faculty members can vary on the basis of the area of expertise. Schloss et al4 estimated faculty turnover cost to range anywhere from $155 000 to $559 000. The impact of such financial burden on health care along with other lesser tangible effects has led to an increased interest in organizational studies. Leadership must take into account perceptions of their organizations to lower faculty dissatisfaction, reduce turnover rate, and enhance patient care through quality management. A meta-analysis on behavioral studies found that employee recognition had just as big an impact as monetary value does on work performance.5 Furthermore, promotions and recognitions can spawn a range of intended and desirable outcomes (ongoing professional growth and confidence). Equipped with this information, we report the development and implementation of the first medical faculty award program in the region. We detail the impact of the program, how it was initiated, and what steps we plan to take to sustain it. The need and the success for this faculty recognition were apparent on a pre- and postaward survey.
MATERIAL AND METHODS In 2012, a year before we initiated the faculty award program, a preassessment survey (Table 1) was sent out to all faculty members via e-mail. The survey was administered electronically, with reminders at 2- to 4-week intervals and eventual follow-up with phone contact when necessary. Responses regarding faculty recognition were gathered through eSurveysPro (www.eSurveysPro.com). The survey used a 1 to 4 rating scale (1, lowest grade; 4, highest grade), yes/no/maybe, and free-text fields. All sessions were anonymized. A postaward survey was
95
Table 1 PREAWARD SURVEY KEY QUESTIONS
Total, n
Frequency, %
Is there a need for employee recognition? Yes 283/307 92% No (if no, Why? open text) 24/307 8% Recognition criteria (select 3 choices) Performance 240/283 78% Quality 182/283 64% Work contribution 147/283 52% Seniority 90/283 32% Work ethic 83/283 29% Adding value 50/283 18% Would recognition increase your performance? Maybe 63/283 22% Yes 137/283 48% No 83/283 30% Would recognition help your promotion? Maybe 113/283 40% Yes 142/283 50% No 28/283 10% Have you thought about switching workplaces Maybe 77/283 27% Yes 92/283 33% No 11/283 40% How would you score the communication level among all providers? 1 26/283 9% 2 118/283 42% 3 77/283 27% 4 62/283 22%
also gathered in a similar fashion except no free text fields were available (Table 2). Program initiation The idea of the award was presented at the annual quality management meeting; members showed unanimous support for the program. As a result of the meeting, members decided on the following 5 awards for each medical specialty (Anesthesia, Family Medicine, Internal Medicine, Surgery, Radiology, Psychiatry, and Obstetrics-Gynecology): 1. Compassionate Physician Award (junior) and Compassionate Physician Award (senior) for
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
96
QUALITY MANAGEMENT
IN
HEALTH CARE/VOLUME 23, ISSUE 2, APRIL–JUNE 2014
Table 2 POST-AWARD SURVEY KEY QUESTIONS
Total, n
Frequency, %
Are the awards popular within your department? Maybe 28/250 11% Yes 213/250 85% No 9/250 4% Would recognition increase your performance? Maybe 65/250 26% Yes 170/250 68% No 15/250 6% Would recognition help your promotion? Maybe 69/250 28% Yes 111/250 44% No 70/250 28% Does the award have any personal value? Maybe 30/250 12% Yes 212/250 85% No 8/250 3% Will a future award help your recognition within your department? Maybe 33/250 13% Yes 197/250 79% No 20/250 8% Will you consider switching workplace in future? Maybe 60/250 24% Yes 39/250 16% No 151/250 60% How would you score the communication level amongst all providers? 1 11/250 4% 2 66/250 26% 3 99/250 40% 4 74/250 30%
faculty members who have demonstrated exceptional patient care. 2. Best Service Award (junior) and Best Service Award (senior) for faculty who has demonstrated exceptional service to the community and the hospital. 3. Best Mentor Award for faculty who has demonstrated exceptional service in guiding younger physicians and residents. 4. Decade of Excellence in Teaching Award for faculty who has demonstrated an outstanding
decade worth of service to the mission of our institution’s educational advancements. 5. Scientific Award for faculty who has demonstrated outstanding research contribution. E-mails calling for electronic nomination letters were sent out to the entire faculty and staff of our institution. The quality of the nominations and the selection of awardees were under the discretion of the selection committee. Selection committee panel Currently, there are 11 people on the review panel, but in each session only 5 randomly selected panelists participate. These panelists are outside recruited university professors with no conflict of interest. Scoring system The selection committee uses a modified weighted criterion to score each letter of nomination. Two panelists who score the nomination on a 50-point scale review each nomination to reach a total of 100 points. Nominations that receive a score of 80 or higher are given the selected award. Venue and timeline The awards were held in our grand conference room a month prior to resident graduation party. All hospital employees were invited. To ensure attendance and participation, winners are declared only at the time of bestowing the award. Figure 1 shows timeline of the activities.
RESULTS A total of 60% (307/509) of registered employees answered the preaward survey (Table 1). Among the
Figure 1. Awards timeline.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Incentivized Practice to Improve Patient Care
respondents, 62% (189/307) were female and 38% (118/307) male. Average age was 37 (±12) of female respondents and 44 (±15) of male respondents. The preaward survey showed that 92% (283/307) of the respondents felt that employee recognition was important and 78% (240/307) felt that performance should be the deciding criteria for employee recognition (Table 1). At the time of the awards, there were 85 full-time faculty members, of whom 24% (20/85) received the decade of excellence award, 13% (11/85) received the compassionate physician award, and 7% (6/85) received the best service award. Forty-nine percent (250/509) of the registered employees completed the postaward survey. The results showed that 68%(170/250) agreed that the award ceremony has incentivized them to increase the quality of their performance. Fifteen percent (3/20) got a promotion (2 department directors, 1 subdirector/consultant of the department of health care management) as a result of their decade of excellence award. Compared to 48% (137/283) of preaward responses that felt recognition would increase their performance; postaward survey showed 68% (170/250) of the respondents stated that recognition would increase their performance.
DISCUSSION It is well documented that the quality of health care closely correlates with the job satisfaction of the health care providers.2,6-9 A study noted that both formal and informal recognition programs provide management with a powerful tool to influence employees to represent their respective institution’s values, create interdepartmental camaraderie, and implement its focused mission.10,11 Our surveybased investigation supports these ideas as we saw a notable change in people wanting to leave the workplace before (33%) and after (16%) the award ceremony. The respondents recognized that performance, quality, and work contribution were important attributes of their job. The most notable result of the postsurvey was that 55% of the recipients felt that the award might contribute to their future pro-
97
motion, and 85% regarded the award as personally valuable. It is our understanding that giving the employees a formal recognition fosters cooperation and communication among health care providers (staff, faculty, and management). Our postaward survey showed increased scoring for the level of communication among providers as opposed to preaward survey. These results convey that respondents appreciated hierarchy/management for the awards program, which 92% (283/307) had asked for in the preaward survey. The faculty members of our institution are involved in medical education and research, which brings about quantifiable improvement in medical advances and in turn the patient outcome. We therefore presented the “Decade of Excellence in Teaching Award,” which till date is the only award that has facilitated the promotion of 3 of our faculty members. We felt that the award recognition was a good incentive to promote our institution’s values, and 68% of the respondents agree as they felt that the recognition would increase their performance. Our hypothesis is consistent with Ruedrich et al.12 A salient disparity in the postaward survey was that while 85% of the respondents felt that the award was popular within their department, only 44% thought it would help their promotion. It is the opinion of the authors that such disparity can be due to the question of validity of these awards given it was only our first year since we began the program. However, the award committee was not compelled to hand out any award if they saw any lack of proof or weak letters of nomination. The committee felt that the value of these awards would weaken if the nominees did not live up to the standards of our institutions mission. In fact, the Scientific Award was not given out this year because the committee felt that there was a lack of worthy nominees. Sustaining and expanding the program Some of the challenges we faced were confusions over the content and the length of the nomination letters. We found many nominators did not adhere to
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
98
QUALITY MANAGEMENT
IN
HEALTH CARE/VOLUME 23, ISSUE 2, APRIL–JUNE 2014
the guidelines (too short or too long) and their letters were sent back for revisions. During the award celebration, the process was described to ensure that everyone recognizes and appreciates that it was transparent and objective. No monetary value was added to the award. Winners were also recognized in the quarterly newsletter of our institution. While the awards were only for faculty members, we collected the opinion of the staff and residents as well to understand the overall management picture of our medical institution. Our future efforts will focus on creating similar incentives for the staff as well as the residents to create an objective evidence of recognition, which ultimately benefits the quality of patient care. Limitations/Future work Despite our conscientious efforts, only 60% completed the preaward survey, and only 49% filled the postaward survey. A number of queries remain to be examined, including elements that affect how department seniority perceives the awards. Moreover, how competitively will these awards be pursued in the future? Do these awards convey camaraderie or create a competitive playing field among departments? What is the effect of the award on those nominated but not selected? Future research should concentrate their efforts on these issues to gauge the complete spectrum of the award programs as an incentive to increase the quality of our current health care.
CONCLUSION In summary, we feel that this transparent, objective, and peer-nominated awards program could
serve as an incentivized model for health care providers to elevate the standards of personal performance, which in turn will benefit the advancement of patient care.
REFERENCES 1. Pololi LH, Krupat E, Civian JT, Ash AS, Brennan RT. Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools. Acad Med. 2012;87(7):859-869. 2. Cropsey KL, Masho SW, Shiang R, et al. Why do faculty leave? Reasons for attrition of women and minority faculty from a medical school: four-year results. J Womens Health (Larchmt). 2008;17(7):1111-1118. 3. Lowenstein SR, Fernandez G, Crane LA. Medical school faculty discontent: prevalence and predictors of intent to leave academic careers. BMC Med Educ. 2007;7:37. 4. Schloss EP, Flanagan DM, Culler CL, Wright AL. Some hidden costs of faculty turnover in clinical departments in one academic medical center. Acad Med. 2009;84(1):32-36. 5. Stajkovic A, Luthans F. A meta-analysis of the effects of organizational behavior modification on task performance. Acad Manage J. 1997;40:1122-1149. 6. Linn LS, Yager J, Cope D, Leake B. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. JAMA. 1985;254(19):2775-2782. 7. Martinson BC, Anderson MS, de Vries R. Scientists behaving badly. Nature. 2005;435(7043):737-738. 8. Mawardi BH. Satisfactions, dissatisfactions, and causes of stress in medical practice. JAMA. 1979;241(14):14831486. 9. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114(6):513-519. 10. Herzberg F. Work and the Nature of Man. Cleveland, OH: World Publishing Company; 1996. 11. Shuaib W, Tiwana MH. Interdepartmental communication. Ir J Med Sci. 2014;183(1):151-152. 12. Ruedrich SL, Cavey C, Katz K, Grush L. Recognition of teaching excellence through the use of teaching awards. Acad Psychol. 1992;16:10-13.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Implementing Incentivized Practice to Improve Patient Care in Developing Countries Zia Mohiuddin, MS; Laura Rosemary Sanchez, MD, MBA; Jose Manuel Alcantra, MD; Waqas Shuaib, MD Introduction: Faculty awards provide an incentive to encourage higher standards of personal performance, which closely reflects the quality of health care. We report the development and implementation of the first medical faculty award program in the region. Material and Methods: Anonymous preaward survey evaluated responses to understand the overall state of our institution. Five awards were celebrated. An anonymous postaward survey gathered responses to evaluate the effectiveness of the program. Results: A total of 60% (307/509) of preaward survey responses were collected. Among those, 92% (283/307) felt that employee recognition was important and 78% (240/307) felt that performance should be the deciding criteria for employee recognition. A 24% (20/85) of the faculty received the decade of excellence award and 13% (11/85) received the compassionate physician award. Best service award was granted to 7% (6/85) of the nominees. Postaward survey showed 68% (170/250) agreed that the award ceremony incentivized them to increase quality of personal performance. Conclusion: In summary, we feel that this transparent, objective, and peer-nominated awards program could serve as an incentivized model for health care providers to elevate the standards of personal performance, which in turn will benefit the advancement of patient care.
Key words: awards, health care, incentivized practice, patient care
I
mprovement in the quality of health care in developing countries has been subtle mostly due to a lack of organizational leadership and financial resources. In light of recent literature, health administrators are taking notice of the negative impact a dissatisfied faculty has on patient care.1 The globally felt 2008 financial crisis lead to a significant downsizing and as a result compromised employee loyalty and commitment. The traditional pay-for-performance methodology has proven to be a valuable asset in incentivizing employees throughout the years. However, in these uncertain financial times, health care managers are seeking other ways to enhance productivity. Medical practices throughout the United States are rapidly becoming evidence-based practices with strong interest in quality management of health care. With higher competition and tighter budgets, quality management is now gaining popularity across borders as management teams are challenged to sustain
Author Affiliations: Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic (Drs Mohiuddin, Sanchez, Alcantra, and Shuaib). Correspondence: Waqas Shuaib, MD, Hospital General de la Plaza de la Salud, Ave. Ortega y Gasset, La Fe, Santo Domingo, Republica Dominicana (Waqas1184@ ´ hotmail.com) The authors thank Luisa J. Polanco for her feedback on the details of the awards timeline and Mario C. Vega for providing missing statistics. Authors Z.M., L.R.S., and J.M.A. designed the survey. W.S. provided statistical support. L.R.S. is the chair of the awards committee and conceived the idea of the manuscript. Z.M. and W.S. wrote the first and the final draft. W.S. takes responsibility for the paper as a whole. There are no financial, consultant, institutional, or other relationships that might lead to bias or a conflict of interest. DOI: 10.1097/QMH.0000000000000027
94 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Incentivized Practice to Improve Patient Care
and offer high-quality medical care. Previous literature shows medical employees’ dissatisfaction may be related to chairman/leadership discontent, lack of recognition in teaching and clinical excellence, and professional advancement issues.2,3 While the option of releasing dissatisfied faculty may seem to be the easy way out, cost of replacing medical faculty members can vary on the basis of the area of expertise. Schloss et al4 estimated faculty turnover cost to range anywhere from $155 000 to $559 000. The impact of such financial burden on health care along with other lesser tangible effects has led to an increased interest in organizational studies. Leadership must take into account perceptions of their organizations to lower faculty dissatisfaction, reduce turnover rate, and enhance patient care through quality management. A meta-analysis on behavioral studies found that employee recognition had just as big an impact as monetary value does on work performance.5 Furthermore, promotions and recognitions can spawn a range of intended and desirable outcomes (ongoing professional growth and confidence). Equipped with this information, we report the development and implementation of the first medical faculty award program in the region. We detail the impact of the program, how it was initiated, and what steps we plan to take to sustain it. The need and the success for this faculty recognition were apparent on a pre- and postaward survey.
MATERIAL AND METHODS In 2012, a year before we initiated the faculty award program, a preassessment survey (Table 1) was sent out to all faculty members via e-mail. The survey was administered electronically, with reminders at 2- to 4-week intervals and eventual follow-up with phone contact when necessary. Responses regarding faculty recognition were gathered through eSurveysPro (www.eSurveysPro.com). The survey used a 1 to 4 rating scale (1, lowest grade; 4, highest grade), yes/no/maybe, and free-text fields. All sessions were anonymized. A postaward survey was
95
Table 1 PREAWARD SURVEY KEY QUESTIONS
Total, n
Frequency, %
Is there a need for employee recognition? Yes 283/307 92% No (if no, Why? open text) 24/307 8% Recognition criteria (select 3 choices) Performance 240/283 78% Quality 182/283 64% Work contribution 147/283 52% Seniority 90/283 32% Work ethic 83/283 29% Adding value 50/283 18% Would recognition increase your performance? Maybe 63/283 22% Yes 137/283 48% No 83/283 30% Would recognition help your promotion? Maybe 113/283 40% Yes 142/283 50% No 28/283 10% Have you thought about switching workplaces Maybe 77/283 27% Yes 92/283 33% No 11/283 40% How would you score the communication level among all providers? 1 26/283 9% 2 118/283 42% 3 77/283 27% 4 62/283 22%
also gathered in a similar fashion except no free text fields were available (Table 2). Program initiation The idea of the award was presented at the annual quality management meeting; members showed unanimous support for the program. As a result of the meeting, members decided on the following 5 awards for each medical specialty (Anesthesia, Family Medicine, Internal Medicine, Surgery, Radiology, Psychiatry, and Obstetrics-Gynecology): 1. Compassionate Physician Award (junior) and Compassionate Physician Award (senior) for
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
96
QUALITY MANAGEMENT
IN
HEALTH CARE/VOLUME 23, ISSUE 2, APRIL–JUNE 2014
Table 2 POST-AWARD SURVEY KEY QUESTIONS
Total, n
Frequency, %
Are the awards popular within your department? Maybe 28/250 11% Yes 213/250 85% No 9/250 4% Would recognition increase your performance? Maybe 65/250 26% Yes 170/250 68% No 15/250 6% Would recognition help your promotion? Maybe 69/250 28% Yes 111/250 44% No 70/250 28% Does the award have any personal value? Maybe 30/250 12% Yes 212/250 85% No 8/250 3% Will a future award help your recognition within your department? Maybe 33/250 13% Yes 197/250 79% No 20/250 8% Will you consider switching workplace in future? Maybe 60/250 24% Yes 39/250 16% No 151/250 60% How would you score the communication level amongst all providers? 1 11/250 4% 2 66/250 26% 3 99/250 40% 4 74/250 30%
faculty members who have demonstrated exceptional patient care. 2. Best Service Award (junior) and Best Service Award (senior) for faculty who has demonstrated exceptional service to the community and the hospital. 3. Best Mentor Award for faculty who has demonstrated exceptional service in guiding younger physicians and residents. 4. Decade of Excellence in Teaching Award for faculty who has demonstrated an outstanding
decade worth of service to the mission of our institution’s educational advancements. 5. Scientific Award for faculty who has demonstrated outstanding research contribution. E-mails calling for electronic nomination letters were sent out to the entire faculty and staff of our institution. The quality of the nominations and the selection of awardees were under the discretion of the selection committee. Selection committee panel Currently, there are 11 people on the review panel, but in each session only 5 randomly selected panelists participate. These panelists are outside recruited university professors with no conflict of interest. Scoring system The selection committee uses a modified weighted criterion to score each letter of nomination. Two panelists who score the nomination on a 50-point scale review each nomination to reach a total of 100 points. Nominations that receive a score of 80 or higher are given the selected award. Venue and timeline The awards were held in our grand conference room a month prior to resident graduation party. All hospital employees were invited. To ensure attendance and participation, winners are declared only at the time of bestowing the award. Figure 1 shows timeline of the activities.
RESULTS A total of 60% (307/509) of registered employees answered the preaward survey (Table 1). Among the
Figure 1. Awards timeline.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Incentivized Practice to Improve Patient Care
respondents, 62% (189/307) were female and 38% (118/307) male. Average age was 37 (±12) of female respondents and 44 (±15) of male respondents. The preaward survey showed that 92% (283/307) of the respondents felt that employee recognition was important and 78% (240/307) felt that performance should be the deciding criteria for employee recognition (Table 1). At the time of the awards, there were 85 full-time faculty members, of whom 24% (20/85) received the decade of excellence award, 13% (11/85) received the compassionate physician award, and 7% (6/85) received the best service award. Forty-nine percent (250/509) of the registered employees completed the postaward survey. The results showed that 68%(170/250) agreed that the award ceremony has incentivized them to increase the quality of their performance. Fifteen percent (3/20) got a promotion (2 department directors, 1 subdirector/consultant of the department of health care management) as a result of their decade of excellence award. Compared to 48% (137/283) of preaward responses that felt recognition would increase their performance; postaward survey showed 68% (170/250) of the respondents stated that recognition would increase their performance.
DISCUSSION It is well documented that the quality of health care closely correlates with the job satisfaction of the health care providers.2,6-9 A study noted that both formal and informal recognition programs provide management with a powerful tool to influence employees to represent their respective institution’s values, create interdepartmental camaraderie, and implement its focused mission.10,11 Our surveybased investigation supports these ideas as we saw a notable change in people wanting to leave the workplace before (33%) and after (16%) the award ceremony. The respondents recognized that performance, quality, and work contribution were important attributes of their job. The most notable result of the postsurvey was that 55% of the recipients felt that the award might contribute to their future pro-
97
motion, and 85% regarded the award as personally valuable. It is our understanding that giving the employees a formal recognition fosters cooperation and communication among health care providers (staff, faculty, and management). Our postaward survey showed increased scoring for the level of communication among providers as opposed to preaward survey. These results convey that respondents appreciated hierarchy/management for the awards program, which 92% (283/307) had asked for in the preaward survey. The faculty members of our institution are involved in medical education and research, which brings about quantifiable improvement in medical advances and in turn the patient outcome. We therefore presented the “Decade of Excellence in Teaching Award,” which till date is the only award that has facilitated the promotion of 3 of our faculty members. We felt that the award recognition was a good incentive to promote our institution’s values, and 68% of the respondents agree as they felt that the recognition would increase their performance. Our hypothesis is consistent with Ruedrich et al.12 A salient disparity in the postaward survey was that while 85% of the respondents felt that the award was popular within their department, only 44% thought it would help their promotion. It is the opinion of the authors that such disparity can be due to the question of validity of these awards given it was only our first year since we began the program. However, the award committee was not compelled to hand out any award if they saw any lack of proof or weak letters of nomination. The committee felt that the value of these awards would weaken if the nominees did not live up to the standards of our institutions mission. In fact, the Scientific Award was not given out this year because the committee felt that there was a lack of worthy nominees. Sustaining and expanding the program Some of the challenges we faced were confusions over the content and the length of the nomination letters. We found many nominators did not adhere to
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
98
QUALITY MANAGEMENT
IN
HEALTH CARE/VOLUME 23, ISSUE 2, APRIL–JUNE 2014
the guidelines (too short or too long) and their letters were sent back for revisions. During the award celebration, the process was described to ensure that everyone recognizes and appreciates that it was transparent and objective. No monetary value was added to the award. Winners were also recognized in the quarterly newsletter of our institution. While the awards were only for faculty members, we collected the opinion of the staff and residents as well to understand the overall management picture of our medical institution. Our future efforts will focus on creating similar incentives for the staff as well as the residents to create an objective evidence of recognition, which ultimately benefits the quality of patient care. Limitations/Future work Despite our conscientious efforts, only 60% completed the preaward survey, and only 49% filled the postaward survey. A number of queries remain to be examined, including elements that affect how department seniority perceives the awards. Moreover, how competitively will these awards be pursued in the future? Do these awards convey camaraderie or create a competitive playing field among departments? What is the effect of the award on those nominated but not selected? Future research should concentrate their efforts on these issues to gauge the complete spectrum of the award programs as an incentive to increase the quality of our current health care.
CONCLUSION In summary, we feel that this transparent, objective, and peer-nominated awards program could
serve as an incentivized model for health care providers to elevate the standards of personal performance, which in turn will benefit the advancement of patient care.
REFERENCES 1. Pololi LH, Krupat E, Civian JT, Ash AS, Brennan RT. Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools. Acad Med. 2012;87(7):859-869. 2. Cropsey KL, Masho SW, Shiang R, et al. Why do faculty leave? Reasons for attrition of women and minority faculty from a medical school: four-year results. J Womens Health (Larchmt). 2008;17(7):1111-1118. 3. Lowenstein SR, Fernandez G, Crane LA. Medical school faculty discontent: prevalence and predictors of intent to leave academic careers. BMC Med Educ. 2007;7:37. 4. Schloss EP, Flanagan DM, Culler CL, Wright AL. Some hidden costs of faculty turnover in clinical departments in one academic medical center. Acad Med. 2009;84(1):32-36. 5. Stajkovic A, Luthans F. A meta-analysis of the effects of organizational behavior modification on task performance. Acad Manage J. 1997;40:1122-1149. 6. Linn LS, Yager J, Cope D, Leake B. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. JAMA. 1985;254(19):2775-2782. 7. Martinson BC, Anderson MS, de Vries R. Scientists behaving badly. Nature. 2005;435(7043):737-738. 8. Mawardi BH. Satisfactions, dissatisfactions, and causes of stress in medical practice. JAMA. 1979;241(14):14831486. 9. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114(6):513-519. 10. Herzberg F. Work and the Nature of Man. Cleveland, OH: World Publishing Company; 1996. 11. Shuaib W, Tiwana MH. Interdepartmental communication. Ir J Med Sci. 2014;183(1):151-152. 12. Ruedrich SL, Cavey C, Katz K, Grush L. Recognition of teaching excellence through the use of teaching awards. Acad Psychol. 1992;16:10-13.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
