Demand Characteristics and Quality Improvement: Who is Fooling Whom?

Abstract

Since some of the data used for quality assurance purposes (i.e. rating scales) requires the active participation of clinicians, administrators use various mandates or incentives to insure its collection. However, although improving clinician compliance these measures may bias clinician responses. It is suggested that the concept of 'demand characteristics' originally developed by Orne to describe how non-specific aspects of the experimental setting shape what the human subject does may be applicable. For example a measure that might increase clinician compliance with completing GAF ratings on an inpatient unit might also influence the scores to make them coincide with the expectation that all patients are very ill when admitted and improved when discharged. Why such a phenomenon would be difficult to detect and what it might say about the relationship between managers and those they manage is also explored.

Social Judgments as a Measure of Right Mindfulness

“…If one accepts the logic that mindfulness should decrease automatic social judgments, then the failure to find a significant relationship between judgment scores and either the FFMQ total, other FFMQ subscales, or the MAAS scores further suggests difficulties with these widely used self-report measures of mindfulness. Self-report measures of personal, internal, and subjective attributes are particularly vulnerable to the influence of demand characteristics and subject bias (Luchins, 2011; Vartanian & Powlishta, 2001), yet, it appears that the use of mindfulness surveys is rarely, if ever, accompanied by procedures to reduce this potential issue. Many studies of mindfulness are likely to have unintentionally included demand characteristics by studying people who are engaged in certain mindfulness activities or by context in clinical settings, or by administering surveys with a description that they are about mindfulness (we have not found any study where the nature of the surveys has been disguised).…”

“…Despite that psychologists are quite sensitive to the potential problem presented by demand characteristics, Nichols and Maner (2008) reported that few researchers actually attempt to control for demand characteristics. Moreover, demand characteristics appear more influential when people are asked to rate themselves (Luchins, 2011). Thus, reporting about one's own "mindfulness" may be particularly vulnerable to such biases.…”