Do Physicians Improve More from Positive or Negative Feedback?

Abstract

We use clinical data on more than 240,000 surgeries and quasi-experimental methods to examine how physicians respond to the surprise release of a performance “report card.” Such feedback interventions are commonly used to encourage physicians to improve performance yet show limited evidence of success. Our results show that these limited effects mask heterogeneous behavioral responses to feedback valence. In particular, physicians improve more from positive feedback than from negative feedback, with negative feedback even reducing performance for a nontrivial share of patients. Experiments with laypersons replicate these results and show that struggles with negative feedback can be mitigated by giving incentives directly tied to improvement and by adding qualitative information that helps individuals interpret past performance. These results are consistent with behavioral models that suggest cognitive and emotional difficulties limit how well individuals use negative feedback. Thus, feedback interventions in healthcare should be carefully designed to mitigate these counterproductive behavioral responses. This paper was accepted by Ranjani Krishnan, accounting. Funding: We acknowledge generous funding provided by Tilburg University and the University of Massachusetts Amherst to run the laboratory experiments. Supplemental Material: The online appendices and data files are available at https://doi.org/10.1287/mnsc.2023.01340 .