Overconfident health workers provide lower quality healthcare
Overconfident health workers provide lower quality healthcare
复制标题
DOI：
10.1016/j.joep.2019.102213
复制
发表时间：
2020-01-01
影响因子：
3.5
通讯作者：
Cairns, John
中科院分区：
文献类型：
--
作者：
Kovacs, Roxanne J.;Lagarde, Mylene;Cairns, John
虽然越来越多的证据表明，低收入和中等收入国家的卫生保健工作者提供的护理质量往往很差，但这种低绩效背后的原因尚不清楚。关于医疗决策的文献表明，认知偏差，或与医疗保健提供者的思维方式有关的失败，解释了许多诊断错误。本研究调查了一种认知偏见，过度自信，定义为倾向于高估自己的表现相对于他人，是否与塞内加尔提供的低质量的护理有关。我们将卫生工作者过度自信的调查数据与他们为标准化患者提供的护理质量的客观衡量标准联系起来，标准化患者是冒充真实患者并记录咨询细节的计数员。我们发现，大约三分之一的医疗服务提供者过于自信，这意味着他们高估了自己与同行相比的能力。然后我们表明，过度自信的提供者不太可能正确管理患者26%，并在临床实践中发挥较少的努力。这些结果表明，在某些情况下观察到的低水平护理质量可以部分解释为提供者的认知偏见，如过度自信。鼓励对卫生保健工作者进行充分监督和反馈的政策可能会减少临床决策中的这种失败。
While a growing body of evidence suggests that healthcare workers in low and middle-income countries often provide poor quality of care, the reasons behind such low performance remain unclear. The literature on medical decision-making suggests that cognitive biases, or failures related to the way healthcare providers think, explain many diagnostic errors. This study investigates whether one cognitive bias, overconfidence, defined as the tendency to overestimate one's performance relative to others, is associated with the low quality of care provided in Senegal. We link survey data on the overconfidence of health workers to objective measures of the quality of care they provide to standardised patients - enumerators who pose as real patients and record details of the consultation. We find that about a third of providers are overconfident - meaning that they overestimate their own abilities relative to their peers. We then show that overconfident providers are 26% less likely to manage patients correctly and exert less effort in clinical practice. These results suggest that the low levels of quality of care observed in some settings could be partly explained by the cognitive biases of providers, such as overconfidence. Policies that encourage adequate supervision and feedback to healthcare workers might reduce such failures in clinical decision-making.