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Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance

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  • Leonard, Kenneth L.
  • Masatu, Melkiory C.

Abstract

Many doctors in developing countries provide considerably lower quality care to their patients than they have been trained to provide. The gap between best possible practice and actual performance (often referred to as the know-do gap) is difficult to measure among doctors who differ in levels of training and experience and who face very different types of patients. We exploit the Hawthorne effect-in which doctors change their behavior when a researcher comes to observe their practices-to measure the gap between best and actual performance. We analyze this gap for a sample of doctors and also examine the impact of the organization for which doctors work on their performance. We find that some organizations succeed in motivating doctors to work at levels of performance that are close to their best possible practice. This paper adds to recent evidence that motivation can be as important to health care quality as training and knowledge.

Suggested Citation

  • Leonard, Kenneth L. & Masatu, Melkiory C., 2010. "Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance," Journal of Development Economics, Elsevier, vol. 93(2), pages 226-234, November.
    • Handle: RePEc:eee:deveco:v:93:y:2010:i:2:p:226-234
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    1. Nazmul Chaudhury & Jeffrey S. Hammer, 2004. "Ghost Doctors: Absenteeism in Rural Bangladeshi Health Facilities," The World Bank Economic Review, World Bank, vol. 18(3), pages 423-441.
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    8. Stephen R G Jones, 1991. "Was There a Hawthorne Effect?," Department of Economics Working Papers 1991-01, McMaster University.
    9. Leonard, Kenneth L., 2008. "Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect," Journal of Health Economics, Elsevier, vol. 27(2), pages 444-459, March.
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    11. Das, Jishnu & Hammer, Jeffrey, 2007. "Money for nothing: The dire straits of medical practice in Delhi, India," Journal of Development Economics, Elsevier, vol. 83(1), pages 1-36, May.
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    13. Leonard, Kenneth & Masatu, Melkiory C., 2006. "Outpatient process quality evaluation and the Hawthorne Effect," Social Science & Medicine, Elsevier, vol. 63(9), pages 2330-2340, November.
    14. Chaudhury, Nazmul & Hammer, Jeffrey S., 2003. "Ghost doctors - absenteeism in Bangladeshi health facilities," Policy Research Working Paper Series 3065, The World Bank.
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    More about this item

    Keywords

    Motivation Practice quality Health care Tanzania Hawthorne effect;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • O1 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development
    • O2 - Economic Development, Innovation, Technological Change, and Growth - - Development Planning and Policy

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