How to Keep Diffusion of Responsibility From Undermining Value-Based Care

Abstract

Diffusion of responsibility describes how individuals can underperform in circumstances of shared accountability. While not well studied in health care settings, this phenomenon is an unintended consequence of the health care sector's complexity and fragmentation. This article considers 3 ways in which monetary and nonmonetary incentives can mitigate negative consequences of diffusion of responsibility. First, incentives should be finite and focused. Second, health care organizations can incentivize both individual and team performance. Third, organizations can use peer comparison feedback to amplify effective incentivizing strategies. Diffusion of Responsibility Diffusion of responsibility describes how individuals can underperform in circumstances of shared accountability. While not well studied in health care settings, the phenomenon has been described in a number of other fields. 1,2,3 It increasingly represents a concern in health care, as care delivery complexity increases and the nation continues to shift toward value-based programs that hold clinicians and organizations financially accountable for the quality and costs of care. Consider care fragmentation-which occurs when patients receive care from multiple clinicians without a main one who guides or coordinates care 4-as a prominent manifestation of diffusion of responsibility. When patients receive care from multiple clinicians in multiple organizations, diffusion of reponsibility can result if each clinician assumes that others have taken on the role of coordination for a patient's care. 5 Unfortunately, a growing body of data demonstrates that higher levels of care fragmentation are associated with adverse outcomes, including increased emergency room, hospitalization, and total health care spending. 6,7

Barriers to Optimal Clinician Guideline Adherence in the Management of Markedly Elevated Blood Pressure: A Qualitative Content Analysis of Electronic Health Records

“…The clinician-related scenarios we have identified, including neglect and diffusion of responsibility, are increasingly concerning within today’s healthcare environment. 21,22 Neglect often occurs when a patient’s primary reason for visiting the healthcare provider is unrelated to hypertension. Meanwhile, diffusion of responsibility arises when clinicians may defer action because they believe someone else, possibly more specialized, should take the lead 23 —this is evidenced in cases where care providers defer the implementation of guidelines to hypertension specialists, even when faced with significantly elevated BP readings.…”

“…The clinician-related scenarios we have identified, including neglect and diffusion of responsibility, are increasingly concerning within today's healthcare environment. 21,22 Neglect often occurs when a patient's primary reason for visiting the healthcare provider is unrelated to hypertension.…”

COVID‐19 and climate change: The social‐psychological roots of conflict and conflict interventions during global crises

“…When considering a global crisis, intrapersonal conflict arises as individuals attempt to distance their attitudes from their behavior through the mechanism of cognitive dissonance (Pearce & Cooper, 2021). Furthermore, diffusion of responsibility often hinders prosocial behaviors or decision-making as individuals attempt to justify their own lack of action (Marcotte et al, 2020). As the impact of the crisis begins to overwhelm social systems and networks, people are likely to experience compassion fatigue and apathy, driving both interpersonal and intergroup conflict (Alharbi et al, 2020;Ruiz-Fern andez et al, 2020).…”

“…Other motivations for responsibility diffusion may resemble the concept of social loafing, for example, choosing to work less when others are also contributing to the work effort in certain group situations (Karau & Williams, 1993), or an egocentric bias to diffusion such that responsibility is claimed only for successes but not for failures (Bond et al, 1984;Forsyth et al, 1981). Another example can be found in public health cases of "care fragmentation," when patients receive care from multiple providers without clear coordination (Marcotte et al, 2020). Regardless of the underlying conflict of interest that motivates an individual's refusal to take responsibility, the consequences of responsibility diffusion during a crisis can be devastating as demonstrated through failed governmental responses by the United States following Hurricane Katrina (Gomez & Wilson, 2008) and the Soviet Union following the Chernobyl nuclear disaster (McClatchey, 1996).…”

An Integrated Care Strategy for Pre-schoolers with Suspected Developmental Disorders: The Optimus Co-design Project that has Made it to Regular Care

“…In fact, the very benchmark of the Optimus integrated care model, the "school function clinic" at the Royal Children's Hospital in Melbourne no longer exists, due to financial unsustainability under the current billing system that cannot accommodate multiple professionals involved in one visit. Further, a care model with several participating organisations entails a risk of diffusion of responsibility [31]. Nevertheless, the Optimus care process continues running today, without the support of the initial project leader and despite changes in staff and no one from the original development team clinically active in the team today.…”