REAL-TIME LOCATION SYSTEMS, NORMATIVE MESSAGING AND CHANGING CLINICIAN BEHAVIOR

Purpose: Modifying physician behavior is notoriously challenging. In the context of increasing demand identifying productive ways to improve physician performance or reduce variability are critical. In this study we take advantage of the fact that physicians are competitive but often have little objective information regarding their own or their peers' performance characteristics. We hypothesized that providing objective normative feedback to physicians on a regular basis would reduce wait time, clinic flow time and face time.

Method: We provided monthly feedback to clinicians in 2 primary care clinics at the individual and group level on wait time, face time and flow time for 6 months. All clinical staff wore RFID-based Real-time location system transponders and all patients were assigned transponders for the visit duration. Wait time was calculated as time from registration to time entering exam room/office, Face time was the duration clinicians and patients were physically co-located in the same exam room/office and flow time was the duration from patient tag registration to its unregistration. All clinicians received the report simultaneously via email at the beginning of each month on the previous month's activity. This contained the performances (mean, interquartile range) on these 3 metrics. Within clinic, individuals could identify their own, their peers and the group performance. The feedback was explicitly framed as objective data without management input and designed to reach all end-users simultaneously. Data was analyzed using standard single and multivariable statistical methods using JMP (SAS, Cary NC)

Results: 2 Clinics and X physicians were tracked and provided feedback from May 2011 through Oct 2011. 2149 unique patient encounters were followed to completion during this period. Staff were satisfied with how the data was presented and found understandable and relevant. Mean wait time decreased significantly for both clinics and mean Flow time for clinic A. Mean face time increase significantly for Clinic B and was unchanged for clinic A. Variability as measured by inter-quartile range decreased and significantly reduced for wait time and flow time p <. 05 using 2 sided F-test, but not for face time. (see table)

Conclusion: In similar fashion to other normative feedback efforts, e.g., electricity bills, clinicians seemed to respond to regular objective feedback by reducing wait time, and flow time and reducing variance in face time.