Do Public Disclosures of Physician Performance Improve Patient Care? The Role of Behavioral Factors

We investigate how a public disclosure of individual surgeon performance affects their patient care (i.e., rates of death and readmission for their patients). While prior research finds that these disclosures lead to modest performance improvements on average, our findings suggest that the on average effects mask substantial heterogeneities. In particular, we find that the disclosure leads to better performance for surgeons who receive positive performance feedback and for those who were already improving quickly before the disclosure. However, it leads to worse performance for surgeons who receive negative performance feedback and for those who were improving less quickly before the disclosure. These results are unlikely to be explained by mean-reversion or changes in patient composition. Instead, the reductions in performance are more consistent with behavioral models that suggest giving individuals additional performance information can induce counterproductive behaviors like dejection, confusion, or a switch to ineffective task strategies. Follow-up experiments with laypersons replicate the surgeon results and suggest that cognitive difficulties drive adverse responses to negative feedback whereas the motivation to improve underlies the effects of pre[1]disclosure improvement rate. Overall, our findings provide a more complete picture on the effects of physician performance disclosures and suggests ways in which they can be improved.