The Hawthorne effect in direct observation research with physicians and patients

Meredith A. Goodwin, Kurt C. Stange, Stephen J. Zyzanski, Benjamin F. Crabtree, Elaine A. Borawski, Sue Flocke

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Rationale, aims, and objectives: This study examines the degree to which a “Hawthorne effect” alters outpatient-visit content. Methods: Trained research nurses directly observed 4454 visits to 138 family physicians. Multiple data sources were used to examine the Hawthorne effect including differences in medical record documentation for observed visits and the prior visit by the same patient, time use during visits on the first versus the second observation day of each physician, and report by the patient, physician, and observer of the effect of observation. Results: Visits on the first versus the second observation day were longer by an average of 1 minute (P <.001); there were time-use differences for 4 of 20 behaviour categories evaluated. No effect of the observer on the interaction was reported by 74% of patients and 55% of physicians. Most of those that reported an affect indicated it was slight. Patients with non-White race, lower-educational level, and poorer health were more likely to report being affected by the observer. Conclusions: In a study that was designed to minimize the Hawthorne effect, the presence of an observer had little effect on most patient-physician visits but appeared to at least slightly effect a subgroup of vulnerable patients.

Original languageEnglish (US)
Pages (from-to)1322-1328
Number of pages7
JournalJournal of Evaluation in Clinical Practice
Volume23
Issue number6
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Epidemiologic Effect Modifiers
Observation
Physicians
Research
Information Storage and Retrieval
Family Physicians
Documentation
Health Status
Medical Records
Outpatients
Nurses

Keywords

  • direct observation
  • Hawthorne effect
  • practice-based research network
  • primary care practice

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

The Hawthorne effect in direct observation research with physicians and patients. / Goodwin, Meredith A.; Stange, Kurt C.; Zyzanski, Stephen J.; Crabtree, Benjamin F.; Borawski, Elaine A.; Flocke, Sue.

In: Journal of Evaluation in Clinical Practice, Vol. 23, No. 6, 01.12.2017, p. 1322-1328.

Research output: Contribution to journalArticle

Goodwin, Meredith A. ; Stange, Kurt C. ; Zyzanski, Stephen J. ; Crabtree, Benjamin F. ; Borawski, Elaine A. ; Flocke, Sue. / The Hawthorne effect in direct observation research with physicians and patients. In: Journal of Evaluation in Clinical Practice. 2017 ; Vol. 23, No. 6. pp. 1322-1328.
@article{f1e6ca19f72d4a278bca28d64f790a5b,
title = "The Hawthorne effect in direct observation research with physicians and patients",
abstract = "Rationale, aims, and objectives: This study examines the degree to which a “Hawthorne effect” alters outpatient-visit content. Methods: Trained research nurses directly observed 4454 visits to 138 family physicians. Multiple data sources were used to examine the Hawthorne effect including differences in medical record documentation for observed visits and the prior visit by the same patient, time use during visits on the first versus the second observation day of each physician, and report by the patient, physician, and observer of the effect of observation. Results: Visits on the first versus the second observation day were longer by an average of 1 minute (P <.001); there were time-use differences for 4 of 20 behaviour categories evaluated. No effect of the observer on the interaction was reported by 74{\%} of patients and 55{\%} of physicians. Most of those that reported an affect indicated it was slight. Patients with non-White race, lower-educational level, and poorer health were more likely to report being affected by the observer. Conclusions: In a study that was designed to minimize the Hawthorne effect, the presence of an observer had little effect on most patient-physician visits but appeared to at least slightly effect a subgroup of vulnerable patients.",
keywords = "direct observation, Hawthorne effect, practice-based research network, primary care practice",
author = "Goodwin, {Meredith A.} and Stange, {Kurt C.} and Zyzanski, {Stephen J.} and Crabtree, {Benjamin F.} and Borawski, {Elaine A.} and Sue Flocke",
year = "2017",
month = "12",
day = "1",
doi = "10.1111/jep.12781",
language = "English (US)",
volume = "23",
pages = "1322--1328",
journal = "Journal of Evaluation in Clinical Practice",
issn = "1356-1294",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - The Hawthorne effect in direct observation research with physicians and patients

AU - Goodwin, Meredith A.

AU - Stange, Kurt C.

AU - Zyzanski, Stephen J.

AU - Crabtree, Benjamin F.

AU - Borawski, Elaine A.

AU - Flocke, Sue

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Rationale, aims, and objectives: This study examines the degree to which a “Hawthorne effect” alters outpatient-visit content. Methods: Trained research nurses directly observed 4454 visits to 138 family physicians. Multiple data sources were used to examine the Hawthorne effect including differences in medical record documentation for observed visits and the prior visit by the same patient, time use during visits on the first versus the second observation day of each physician, and report by the patient, physician, and observer of the effect of observation. Results: Visits on the first versus the second observation day were longer by an average of 1 minute (P <.001); there were time-use differences for 4 of 20 behaviour categories evaluated. No effect of the observer on the interaction was reported by 74% of patients and 55% of physicians. Most of those that reported an affect indicated it was slight. Patients with non-White race, lower-educational level, and poorer health were more likely to report being affected by the observer. Conclusions: In a study that was designed to minimize the Hawthorne effect, the presence of an observer had little effect on most patient-physician visits but appeared to at least slightly effect a subgroup of vulnerable patients.

AB - Rationale, aims, and objectives: This study examines the degree to which a “Hawthorne effect” alters outpatient-visit content. Methods: Trained research nurses directly observed 4454 visits to 138 family physicians. Multiple data sources were used to examine the Hawthorne effect including differences in medical record documentation for observed visits and the prior visit by the same patient, time use during visits on the first versus the second observation day of each physician, and report by the patient, physician, and observer of the effect of observation. Results: Visits on the first versus the second observation day were longer by an average of 1 minute (P <.001); there were time-use differences for 4 of 20 behaviour categories evaluated. No effect of the observer on the interaction was reported by 74% of patients and 55% of physicians. Most of those that reported an affect indicated it was slight. Patients with non-White race, lower-educational level, and poorer health were more likely to report being affected by the observer. Conclusions: In a study that was designed to minimize the Hawthorne effect, the presence of an observer had little effect on most patient-physician visits but appeared to at least slightly effect a subgroup of vulnerable patients.

KW - direct observation

KW - Hawthorne effect

KW - practice-based research network

KW - primary care practice

UR - http://www.scopus.com/inward/record.url?scp=85026395617&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85026395617&partnerID=8YFLogxK

U2 - 10.1111/jep.12781

DO - 10.1111/jep.12781

M3 - Article

C2 - 28752911

AN - SCOPUS:85026395617

VL - 23

SP - 1322

EP - 1328

JO - Journal of Evaluation in Clinical Practice

JF - Journal of Evaluation in Clinical Practice

SN - 1356-1294

IS - 6

ER -