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Open Access Publications from the University of California

Monetary Resident Incentives: Effect on Patient Satisfaction in an Academic Emergency Department


Patient satisfaction must be a priority in emergency departments (EDs). The care provided by residents forms much of the patient contact in academic EDs.

Objective: To determine if monetary incentives for emergency medicine (EM) residents improve patient satisfaction scores on a mailed survey.

Methods: The incentive program ran for nine months, 199-2000. Press-Ganey survey responses from ED patients in 456 hospitals; 124 form a peer group of larger, teaching hospitals. Questions relate to: 1) waiting time, 2) taking the problem seriously, 3) treatment information, 4) home care concerns, 5) doctor’s courtesy, and 6) concern with comfort. A 5-point Likert scale ranges from “very poor” (0 points) to “very good” (100) Raw score is the weighted mean, converted to a percentile vs. the peer group. Incentives were three-fold: a year-end event for the EM residents if 80th percentile results were achieved; individual incentives for educational materials of $50/resident (50th percentile), $100 (60th), $150 (70th), or $200 (80th); discount cards for the hospital’s espresso cart. These were distributed by 11 EM faculty (six cards/month) as rewards for outstanding interactions. Program cost was <$8,000, from patient-care revenue. Faculty had similar direct incentives, but nursing and staff incentives were ill defined and indirect.

Results: Raw scores ranged from 66.1 (waiting time) to 84.3 (doctor’s courtesy) (n=509 or ~7.2% of ED volume). Corresponding percentiles were 20th-43rd (mean=31st). We found no difference between the overall scores after the incentives, but three of the six questions showed improvement, with one, “doctors’ courtesy,” reaching 53rd percentile reward.

Conclusions: Incentives are a novel idea to improve patient satisfaction, but did not foster overall Press-Ganey score improvement. We did find a trend toward improvement for doctor patient interaction scores. Confounding variables, such as increasing patient census, could account for inability to demonstrate positive effect.

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