These days it seems that everyone wants primary care providers (PCPs) to change, and to improve.
If you believe in better healthcare through use of new technologies, then you want PCPs to adopt new technologies –both within their offices (EMRs and care coordination platforms) and by engaging with technology in the patient’s environment (smartphone apps, aging-in-place technology, etc).
In other words, you want PCPs to do things like prescribe apps (see here for Susanna Fox’s comments on clinicians and stagnant health app adoption), and integrate “observations of daily living” into their clinical work. Or maybe even practice like Eric Topol (see here for why I’d have trouble doing it).
If you believe in more patient-centered and individualized care, then you want PCPs to spend more time developing meaningful collaborations with patients and families. You may also want PCPs to start relying on more accurate individually-generated medical data to make clinical recommendations.
In other words, you want PCPs to consider a patient’s genomic information or personal biometric data set when recommending treatments, and you want them to engage in shared decision-making.
And if you believe in patient and caregiver engagement, then you want PCPs to support and respond to that engagement.
In other words, you’ll want PCPs to encourage, collaborate with, and coach patients and caregivers on successfully managing their health needs, and you’ll want PCPs to be more available to respond to patients’ concerns.
Sounds good to me. I believe in all three of these ideas. The second and third are core components of the geriatric approach (albeit historically done in a much less tech and data intensive fashion), and I think properly leveraging technology will be essential to managing the considerable needs of an aging population in a time of limited resources.
Furthermore, we expect all the above to lead to the holy grail of healthcare improvement: better care at a lower cost. This is plausible: health services research shows that a better primary care infrastructure generally corresponds to better population health outcomes, and more cost-effective care.
Plus, people seem to like having good primary care. Almost everyone prefers to have their health problems treated in the outpatient setting, and would like medical intervention earlier, in order to avoid hospitalizations.
In other words, PCP behavior change seems to be the great hope for improving US
healthcare. (It’s certainly my own great hope for improving outpatient
geriatric care, since most of that care will be delivered by the
nation’s non-geriatrician PCPs.)
Which is why I think all of us advocating for healthcare change, healthcare improvement, and healthcare tech adoption should be spending lots of time talking about how to motivate and enable PCPs to make these changes.
And if you believe in the motivation science presented in Daniel Pink’s “Drive” – and so far I do — then we should definitely emphasize harnessing PCP’s intrinsic motivation to be better PCPs. (See here for why I think this is important to the healthcare of seniors and frail elders.)
So, I’m currently considering attention to PCP intrinsic motivation as I come across various stakeholders discussing desired changes to the healthcare system.
For instance, in a recent blog post, Caroline Popper describes how she’s helping HHS figure out how to “move reimbursements from ‘fee for services’ to ‘fees for
performance.'” She asks “how do you measure performance? How do
you pay for it?”
Well, those are literally billion dollar questions. If she thinks PCP behavior change is part of the answer, then I hope she and her team will consider the way monetary incentives tamper with intrinsic motivation in professionals. (At the very least we might want to have ACOs be very careful about the way they try to apply incentives to PCP behaviors.)
In another recent post, a mHIMSS editor comments on the need for physician champions to help take mHealth to the next level.
I am all for it, but historically exhorting PCPs to do more or do better hasn’t been enough (although it probably helps to hear it from another PCP). If the mHealth community wants PCPs to engage, can they help create PCP working conditions that nurture internal drive, rather than attempt to change PCPs with monetary incentives?
What about the rest of you? What do you think are viable ways to motivate PCPs to engage and adapt to change?
In a nutshell
The overall improvement of healthcare, especially for seniors, hinges on developing a better system of primary care. This will require PCPs to make substantial behavior changes, especially if adopting new technologies and new ways of practice are required.
The social science described in Daniel Pink’s “Drive” describes the perils of relying on external rewards and punishments, when trying to motivate people to do their best work. In particular, such strategies can seriously erode intrinsic motivation, which is often key to performing creative work or empathic work.
The healthcare changes we all want will require PCPs to step up and do their best creative and emphathic work. If we want PCPs to engage and be open to using new technologies, how can we help harness their intrinsic motivation?
Ideas sorely needed.
