Sunday, December 4, 2016

How NOT to motivate physicians: lessons from Cuba

Cuba penalizes physicians for "not meeting quotas" on infant mortality.  How do they respond?
  • When pregnancies are deemed risky, doctors have to coerce women to undergo abortion in spite of their wishes. 
  •  On top of this, forced sterilization in some cases are an actually documented policy tool. These restrictions do reduce mortality, but they feel like a heavy price for the people. 
  •  ...doctors ... lie about the statistics. One thing that is done by the regime is to categorize “infant deaths” as “late fetal deaths” – its basically extending the definition in order to conceal a poorer performance.
What happens when you adjust the infant mortality statistics?
  • ...Cuba moves from having an average infant mortality rate ... to having the worst average infant mortality in that dataset – above that of most European and North American countries.


  1. Doctors will always gravitate towards improving the metrics they are 'graded' on. It is very difficult because with each new metric, it negatively effects another. And in that other metric are patients and lives! Great post. The question is: How can we motivate physicians to improve on all metrics? Is there a way to quantify their work?

  2. Module 3 Blogspot #1

    I think of the better ways to motivate physicians and a better way to track patient care is to track outcomes. Rather than giving them a goal of “reduce infant mortality by x% or by X number,” track what they are doing and what their outcome actually is. Look at all of the data rather than what the physician is doing. How many infant mortalities were caused because of actions of the mother or actions outside of the physician’s mother’s control (i.e. car accidents?).

    Additionally, if you were to take a look at a different profession, such as physical therapy, how could you measure their outcomes? How many visits does it take a PT who specializes in the spine to get someone who is experiencing sciatica better versus a PT who does not specialize in the spine?

    Lastly, one of the other obstacles that U.S. Healthcare faces is the money aspect. Insurance companies are all about not paying for services and doctors are all for billing every single test. There needs to be a better balance in order for the insurance companies and medical professions to work together in order to provide the best patient care. Not everyone can afford test after test but on the other hand, doctors shouldn’t be running unnecessary or extensive testing just because the patient’s insurance will cover it.

    Overall, there needs to be a better system in place to provide the best patient care not only across the U.S., but across the world.

  3. The recent changes in healthcare management have weighed heavily on many practitioners and administrators alike. “What I thought for a long time was real anger turned out to be feeling vulnerable,” says Dr. Kent Bottles, Chief Medical Officer of PYA Analytics and a Consulting Principal at PYA. “Physicians thought they had paid their dues and would not have to scrabble this much to maintain their lifestyle.” Motivating physicians is one way to improve patient satisfaction; it has become vital that your physicians work towards a common goal. I believe to improve a patient physician satisfaction we need to get to the Root Cause of their dissatisfaction
    If physicians are disengaged and unhappy, it becomes our responsibility to find the cause of their unhappiness.
    Bottles says that when he realized the difference, he was better able to help physicians become motivated in patient satisfaction, meeting quality metrics and making changes necessary to cope with the transformation of the American healthcare delivery system. In today's environment, most physicians want to focus on their patients and be removed from the administrative burdens the system has placed on them, if we find ways to remove the administrative and financial responsibilities from physicians so they can put all their efforts into patient care, it will go a long way to increases patient and physician satisfaction