How Relative Performance Feedback Can Motivate Doctors

Receiving feedback on their performance relative to their peers is a common practice among physicians to enhance the quality of care. However, the way this feedback is structured—particularly the ranking system—significantly influences whether it inspires improvement or leads to demotivation. Crucially, the design of the ranking thresholds, which determine top performers and outstanding performance levels, must strike a balance: they should not be set too low to undermine challenge nor too high to discourage effort.

A recent study by researchers from the University of Cologne’s Department of Health Economics, in collaboration with colleagues from the University of Münster, highlights these nuances. Their findings, published in Management Science, suggest that performance rankings can serve as powerful motivators if carefully tailored to the abilities of individual doctors and teams.

In hospitals, ranking systems that compare doctors' performance based on key quality indicators—like adenoma detection rates—can promote social comparison, fostering a competitive environment aimed at improvement. Yet, a key challenge persists: setting performance thresholds too high may demotivate those who believe they cannot meet the standard, while too low thresholds might fail to motivate. Thus, designing effective rankings requires a nuanced understanding of team capabilities.

Behavioral economic experiments involving 112 practicing doctors and 240 medical students revealed that motivational effects depend heavily on how rank thresholds are determined. Using systematic variation, the researchers found that no single fixed design works universally—rankings should instead be customized based on the individual and collective abilities within a team.

According to Yero Ndiaye, a doctoral researcher involved in the study, "A well-designed ranking system should be adapted to the team's capabilities to motivate as many doctors as possible without causing frustration." Moreover, continuous measurement of key performance indicators, regular feedback, and ongoing training are vital components for successful implementation in clinical practice.

Professor Dr. Daniel Wiesen emphasizes that although preliminary evidence is promising, more long-term, real-world studies are needed to confirm the effectiveness of tailored ranking systems in healthcare settings. He highlights that an ongoing challenge is balancing motivational thresholds to maximize effort without unintended demotivation.

In conclusion, ranking systems can be valuable tools to foster quality improvement among physicians when thoughtfully designed. Tailoring performance thresholds to individual skill levels and ensuring ongoing feedback and training can promote a culture of continuous improvement in hospitals.

[Source: https://medicalxpress.com/news/2025-06-feedback-doctors.html]