THE DILUTING EFFECT OF MEDICAL WORK GROUPS ON FEEDBACK EFFICACY IN CHANGING PHYSICIANS PRACTICE

Feedback intervention has been advocated as a successful method to mod ify the way that physicians practice medicine. However most studies co ncerned with modifying physician profiles have focused on interns and residents. The results presented here concern regular staff and theref ore provide a better basis for generalization. Over a 2.5-year period, we analyzed the use of clinical resources by physicians practicing in four medical specialties in two hospitals. Hierarchical multiple regr ession models were used to control case mix in order to identify the s pecific effects attributable to feedback. The information failed to mo dify the physicians' practice profiles. Our results suggest that this failure is related to the organization of inpatient medical practice a s a group effort This mode of practice has a negative effect on feedba ck efficacy First, it weakens one of the main feedback mechanisms, tha t is personal identification with the data. Second, it probably genera tes mutual adjustment among physicians, thus eliminating practice vari ations at the source.