The final paragraph of the article is particularly enlightening:
Judgmental programs tend to interfere with quality improvement. They score but do not support physician work and therefore are perceived by physicians as disempowering. Accountability combined with perceived inability to improve is a formula for creating frustration and antagonism. We propose instead an approach that identifies specific wasteful practices and then engages physicians in changing them.So it appears to be possible to engage physicians in quality improvement (QI) and achieve goals of cost reduction and reducing overuse, as long as it is in the context of improving care, something most physicians care passionately about. As long as they are cast as part of the problem, why would they do anything other than sabotage the solution?
I do not know many physicians who are heavily involved in quality improvement, but I have learned from recent experience, that physicians who have been beaten up by QI programs are very likely to resist and attack anyone who comes to them with a quality agenda, irrespective of their credentials. That is to say, the stupidity of others impairs quality-committed physicians ability to effect change and that needs to be part of an environmental assessment for any new quality management project.
OK, it seems obvious, but I'm human too!