A Hawthorne strategy: implications for performance measurement and improvement.

The Hawthorne experiments are a backdrop for diverse studies assessing the impact of treatment and experimentation on human and organizational performance. The Hawthorne effect is used to describe the positive impact on behavior that sometimes occurs in a study or experiment as a result of the interest shown by the experimenter in humans who are being treated, studied, or observed. We propose that the Hawthorne effect can be viewed as an active construct to develop a coherent strategy for performance improvement. We propose a "Hawthorne strategy" that transcends the Hawthorne effect in that it offers an approach to improving performance indefinitely. This strategy uses external observations of performance to increase internal commitment to performance improvement. The focus of individual responsibility increases as does the perceived connection between individual efforts and external performance improvement. The sense of accountability is maintained by institutional recognition and periodic reinforcement of individual behaviors that contribute to performance improvement. A successful Hawthorne strategy encourages providers of care to be evaluators of their performance as individuals, as members of groups, and as members of institutions.