When peer comparison information harms physician well-being.

Motivating physicians to adhere to medical best practices is a constant concern for health system leaders and policymakers. Meanwhile, burnout rates among physicians are rising—often resulting in mental health problems, job turnover, and higher healthcare costs. In our study, a commonly used behavioral intervention—informing physicians about how their performance compares to that of their peers—has no statistically significant impact on performance. However, it does decrease physicians’ job satisfaction and increase burnout. We uncover one mechanism behind this backfiring effect, namely, that the intervention may signal a lack of leadership support. Consistent with this account, we find that training leaders to offer support offsets the negative impact. We discuss lessons for the design, implementation, and evaluation of behavioral interventions and policies. Policymakers and business leaders often use peer comparison information—showing people how their behavior compares to that of their peers—to motivate a range of behaviors. Despite their widespread use, the potential impact of peer comparison interventions on recipients’ well-being is largely unknown. We conducted a 5-mo field experiment involving 199 primary care physicians and 46,631 patients to examine the impact of a peer comparison intervention on physicians’ job performance, job satisfaction, and burnout. We varied whether physicians received information about their preventive care performance compared to that of other physicians in the same health system. Our analyses reveal that our implementation of peer comparison did not significantly improve physicians’ preventive care performance, but it did significantly decrease job satisfaction and increase burnout, with the effect on job satisfaction persisting for at least 4 mo after the intervention had been discontinued. Quantitative and qualitative evidence on the mechanisms underlying these unanticipated negative effects suggest that the intervention inadvertently signaled a lack of support from leadership. Consistent with this account, providing leaders with training on how to support physicians mitigated the negative effects on well-being. Our research uncovers a critical potential downside of peer comparison interventions, highlights the importance of evaluating the psychological costs of behavioral interventions, and points to how a complementary intervention—leadership support training—can mitigate these costs.

激励医生遵循最佳医疗实践一直是卫生系统领导者和政策制定者关注的问题。与此同时，医生的职业倦怠率不断上升——这往往导致心理健康问题、人员流动以及更高的医疗成本。在我们的研究中，一种常用的行为干预措施——告知医生他们的表现与同行相比如何——对绩效没有统计学上的显著影响。然而，它确实降低了医生的工作满意度并增加了职业倦怠。我们揭示了这种适得其反的效果背后的一种机制，即该干预措施可能表明缺乏领导支持。与这一解释相符的是，我们发现对领导者进行提供支持的培训可以抵消负面影响。我们讨论了行为干预措施和政策的设计、实施和评估方面的经验教训。 政策制定者和企业领导者经常使用同行比较信息——向人们展示他们的行为与同行相比如何——来激励一系列行为。尽管它们被广泛使用，但同行比较干预措施对接受者福祉的潜在影响在很大程度上是未知的。我们进行了一项为期5个月的实地实验，涉及199名初级保健医生和46631名患者，以研究同行比较干预措施对医生工作绩效、工作满意度和职业倦怠的影响。我们改变了医生是否收到与同一卫生系统中的其他医生相比其预防保健绩效的信息。我们的分析表明，我们实施的同行比较并没有显著提高医生的预防保健绩效，但它确实显著降低了工作满意度并增加了职业倦怠，在干预措施停止后，对工作满意度的影响至少持续了4个月。关于这些意外负面效应背后机制的定量和定性证据表明，该干预措施无意中表明缺乏领导支持。与这一解释相符的是，为领导者提供如何支持医生的培训减轻了对福祉的负面影响。我们的研究揭示了同行比较干预措施的一个关键潜在不利方面，强调了评估行为干预措施心理成本的重要性，并指出了一种补充干预措施——领导支持培训——如何能够减轻这些成本。