In a reading room as on an assembly line, monitored workers do more work

Just as factory workers become more diligent when they know they’re being watched, so too radiologists increase their work relative value units (wRVUs) after their practice implements a real-time productivity monitoring system (RTPMS).

This “Hawthorne effect” was described in 1950 by the (now emeritus) sociology professor Henry Landsberger of the University of North Carolina after he analyzed the results of a 1920s productivity experiment conducted at the Hawthorne Works, a factory in Illinois.

Its corollary observation in radiology is described in a case study conducted by Arif S. Kidwai, MD, MBA, founder of the Jacksonville, Fla.-based Profound Radiology consultancy, and Hani H. Abujudeh, MD, MBA, of Harvard Medical School and Massachusetts General Hospital.

Their work posted July 22 in the Journal of the American College of Radiology.

Kidwai and Abujudeh found that radiologist hourly wRVU productivity increased 21 percent—and daily wRVU productivity increased 45.5 percent—after an RTPMS was instituted, and staffing subsequently adjusted with decisions to downsize.

The practice under the microscope was a small private group whose six fulltime rads, one of whom was Kidwai, worked mostly on unassigned patient cases and self-selected studies to read based on their respective specialties and preferences.

The 12-month window the authors looked at included a pre-implementation baseline period and three periods, each with a variation in radiologist headcount, while the RTPMS was in place.  

Kidwai and Abujudeh assessed each period for individual hourly wRVU productivity, individual daily wRVU productivity, unread worklist volume, central shift unread worklist volume and daily percentage of “starving” radiologists—meaning instances where the unread case buffer totaled less than 7.22 wRVUs.

Financial incentives for productivity were not a factor before or after the RTPMS implementation, and the practice did not prospectively plan to downsize the daily staff volume at the onset of monitoring, according to the study report.

Rather, the practice’s radiologists “collectively made operating decisions based on their perception of the practice needs,” the authors write.

In one period, decreasing staff level to 3.6 rads resulted in a 20.7 percent decreased central shift volume, from 13.5 to 10.7 wRVU.

“The increased reading efficiency with fewer radiologists may seem counterintuitive because one would expect the unread worklist to be larger with fewer staff members, but this phenomenon can be explained by the law of diminishing returns,” the authors write. “In the realm of manufacturing, this law explains that overstaffing decreases average worker output, because too many workers ultimately interfere with each other’s production.”

For all the numbers and their corresponding correlations with manufacturing’s Hawthorne effect, click here.