Reputations count: why benchmarking performance is improving health care across the world

Abstract

This paper explores what motivates improved health care performance. Previously, many have thought that performance would either improve via choice and competition or by relying on trust and altruism. But neither assumption is supported by available evidence. So instead we explore a third approach of reciprocal altruism with sanctions for unacceptably poor performance and rewards for high performance. These rewards and sanctions, however, are not monetary, but in the form of reputational effects through public reporting of benchmarking of performance. Drawing on natural experiments in Italy and the United Kingdom, we illustrate how public benchmarking can improve poor performance at the national level through 'naming and shaming' and enhance good performance at the sub-national level through 'competitive benchmarking' and peer learning. Ethnographic research in Zambia also showed how reputations count. Policy-makers could use these effects in different ways to improve public services.

Insights on the effectiveness of reward schemes from 10‐year longitudinal case studies in 2 Italian regions.

“…Indeed, when all these governance tools are put in place, the incentive size seems not important ( how much to reward ) as the results obtained for the percentage of femur fractures operated within 2 days suggest. When GMs' goals are aligned to those of organisations and focus on quality and appropriateness measures that closer to professionals activities (what) , it is possible to enable the mechanism of identity above all throughout reputation lever …”

“…Finally, some governance mechanisms such as publicly benchmarking outcomes and peer learning can motivate improved performance at both the sub‐national and national level but with careful design . In particular, improving results requires different approaches when the context is poor or good performing: while naming shaming and punishment may help in the case of poor performance, awards and visibility may help in the case of good performance …”

Health system performance assessment in small countries: The case study of Latvia

“…Although it seems like a trivial aspect, the publishing of results can have important effects on healthcare organizations and professionals, especially when it is linked to governance strategies. These effects are mainly related to reputation mechanisms and to the rise of potential performance distortions—eg, “gaming”—if the HSPA and the performance targets linked to it are not properly designed . In synthesis, literature agrees that transparent disclosure of performance‐related data is a positive driver as long as it is implemented so as to leverage on reputation levers and it takes into account the governance system in which it is applied as a whole in order to avoid unintended consequences …”

Reputation‐Sets

“…Research and practitioner interest in reputation has grown rapidly in recent years. The literature focused on reputation has shown impressive expansion (see, e.g., the works of Barnett, Jermier, & Lafferty, ; Barnett & Pollock, ; Bevan, Evans, & Nuti, ; Eccles, Newquist, & Schatz, ; Fombrun, ; 1997; Fombrun & Shanley, ; Gotsi & Wilson, ; Kelley & Thams, ; Newburry, Deephouse & Gardberg, ; Lee, Lim, & Drumwright, ; Mitnick & Mahon, ; Mahon & Mitnick, ; Mason, ; Pérez‐Cornejo et al, 2018; Pollock et al, ; Ravasi et al, 2018; Vock, Ward, & Campbell, ; and the establishment of Corporate Reputation Review as an outlet for this research). This level of activity has had rippling effects on research in related as well as more encompassing fields.…”