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Aligning incentives for academic physicians to improve health care quality.

ACADEMIC HEALTH SCIENCE CENTERS PLAY A LEADing role in the development of new knowledge, yet the quality of care in academic hospitals is on average only modestly better than that of care provided by community hospitals. However, averages are also misleading. In one study evaluating care of patients with acute coronary syndrome, 15 of the 20 top-performing institutions were community hospitals. Indeed, many organizations that have been at the forefront of the quality improvement movement, such as Intermountain Healthcare and Geisinger Health System, are not among the highest-ranked academic centers in terms of research grants and research productivity. One reason academic health science centers do not consistently provide superior care may be the incentive structures that exist within them for academic physicians. These physicians determine not only what research is undertaken but also how clinical care is delivered and how much attention is given to quality improvement. The choices that academic physicians make, and the incentives that affect those choices, have a profound influence not only on knowledge generation but also on the quality of health care received by millions of patients. In this Commentary, we suggest that academic physicians currently face financial and nonfinancial incentives that discourage the expenditure of time and energy on projects likely to improve patient care in their local environments. These incentives will need to change if academic health science centers are to become leaders in quality improvement.