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Ashish K. Jha, MD, PhD on the Effects of Incentives on Quality of Care and Provider Behavior

Today we are delighted to welcome Ashish K. Jha, MD, PhD as a Keynote Speaker for this Breakthrough Opportunities event on Designing Provider Incentives with the Commonwealth Fund.

Dr. Jha is Director for the Harvard Global Health Institute, K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health, Professor of Medicine at Harvard Medical School, and a practicing Internal Medicine physician at the VA Boston Healthcare System.

In this video, Dr. Jha discusses the effects of public reporting and financial incentives on quality of care, and how they can be used in effective incentive programs.

We look forward to hearing your thoughts on Dr. Jha’s video below, and encourage you to submit ideas sparked by the topics covered:

(Note for those viewing this update via email, please click through to view Dr. Jha’s video on GHDonline:


Matteo M Galizzi Advisor Replied at 5:03 PM, 10 Dec 2015

1. Beautiful reminder that we should focus on 'outcomes that matter'.
2. Equally beautiful reminder on the need of simplicity of the incentive schemes.
3. Personally I am not that sure that we currently have good evidence from behavioural economics that incentives dampen internal motivation. Evidence is actually mixed at best.

Paul Nelson Replied at 11:45 PM, 10 Dec 2015

The Design Principles for effective and efficient collective action exist and have been substantially verified: see link below to the Cooperative Commons. A substantial component of unstable HEALTH has its origin in the character of a person's community and its neighborhoods. We have recently demonstrated the utility of community based collective action strategy to reduce our nation's homeless, especially those with high-risk personal attributes. It seems that if a collective action process was implemented by each community to promote the overall HEALTH of its citizens, then the role of community physicians in this process could also serve as an entry into a more focused collective action effort by the community's healthcare industry, especially for Basic Healthcare Needs.

Attached resource:

Maggie Sullivan Advisor Replied at 1:14 PM, 11 Dec 2015

I appreciate Dr Jha's comment about physicians [providers] wanting to delivery high quality care, but often feeling unable to do so. I agree that the vast majority of providers want to do 'right' by their patients as well as their own professional reputations, financial incentive or not. However, there are so many clinical/organizational environments as well as social/economic health determinants that make this work more difficult than it needs to be. Incentives are not meant to correct an internal wayward streak within us, but to create systems that make it easier for us to do the kind of job we want to do. If I am seeing 25 patients per day in an outpatient primary care setting, and I don't have language interpretation, an EMR that is easy to use, nursing and reception staff that are competent and supportive, simple referral processes, knowledgeable case managers, accessible behavioral health, etc, then my interaction with patients will reliably be of poor quality and outcome. If systems are created to help us succeed, we will succeed more often.

BAMAL'EMPYULO AUGUSTIN KARUMBA Replied at 1:50 PM, 11 Dec 2015

Thank you for this short yet wonderful presentation. indeed the lack of incentive of any kind is lacking in many organisations. Human resources has been too short for so long and clinicians walking away due to job insatisfaction yet if incentives were given they could remain. incentives as a motivation, recognition, acknowledgement given to individuals in terms of money, including scholarships, promotion to high performant. this should be not sporadic but consistent (sustainable) so rather never start if it cant go far.
The republic of Rwanda is one i found this year caring out systematically and consistently incentive based job performance at all the ministries and at al the levels including the community healthcare workers.
They assign and submitt their project with measurable indicators and the measured achievement is rewarded in terms of money, in nature and promotion from individuals to groups achievers.
The rwandese government has adopted and implement single project approach and the M & E team submit regularly the outcome and impact achievement. Incetive is the way to for job improvement through measured achievements

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