The Hawthorne Effect in chiropractic practices and health care

The Hawthorne Effect and using the famed study to achieve maximum benefits for your chiropractic office

Not everyone recognizes the classic business term The Hawthorne Effect. This label has been around for some time, and it comes to us with an enduring history in business.

But if you know the concept by name — if you call it something at all — it’s likely that this principle is already hard at work in some parts of your office. Frankly, this is a concept that can effectively define and improve nearly every facet of your practice. Here’s where and how every chiropractic office can score maximum and positive benefits.

Improvement principles

This concept quantifies critical performance and organization improvement principles for:

• Documenting patient care, progress and outcomes
• Patient satisfaction, compliance and follow-up
• Marketing and advertising; return on investment
• Individual and staff incentives, goal setting and personal growth
• Tracking and achieving critical success factors and business objectives

First, the brief backstory. The now-famous industrial project began in 1924 when Harvard Business Professors Mayo and Roethlisberger studied worker productivity at Western Electric’s Hawthorne facility. The electric company had commissioned research to determine if there was a relationship between productivity and work environments.

The original purpose of the Hawthorne studies was to examine how different aspects of the workspace, such as lighting, the timing of breaks, and the length of the workday, had on worker productivity. Additional studies continued over several years. But it turned out that the study itself — not the lighting or other work environment changes — was making the difference.¹

“The Hawthorne Effect — a term coined in the 1950s — describes the phenomenon of test subjects changing their performance in response to being observed, as some Hawthorne employees did when they knew they were part of the study.”²

The power of observation

Although thoughtful discussion about these studies continues, the broad concept suggests that it is human nature for people to change or improve their behavior due to their awareness of being observed or monitored. In some instances, people may simply work harder. But with specific and quantified goals and objectives, individuals can focus their efforts on achieving measurable and positive change for the benefit of the patient and the practice.

Subsequently, the social science world came to connect business progress and success with a modern, human-centered environment. And, to distill the concept, doctors, office managers and employees recognize that people’s performance improves when work is being measured. The contemporary quick notes (and variations) for every DC’s office are:

• What gets measured, gets done
• What gets measured, gets improved
• If you don’t measure it, you can’t manage it

Quantify and measure

One of the strongest and widely applicable of the Hawthorne tenets is the concept that having a quantifiable measure is a means to gauge progress and success. What’s more, it guides changes — to correct misdirection and/or direct improvements. Some objectives can get stalled at a vague-and-lofty stage that lacks a quantifiable indicator of progress (or perhaps a lack of progress). Is there specific progress within the practice, and/or clear contribution to the business bottom line?

Being “busy” is not the same as being productive or effective. And, without specific numbers, there is no accurate picture. The individual responsible and accountable for the goal — as well as the supervisor — doesn’t know how they’re doing.

Nearly every chiropractic practice faces challenges: to support daily operations and meaningful goals through resource allocation and a balanced budget. Without specific measures for every facet of the practice, it’s nearly impossible to manage patient care, as well as staff performance and business goals. To illustrate, one of our favorite business examples is a marketing fundamental. That is, advertising, or any promotional activity, needs to be performance-driven. In marketing, the “Hawthorne” name usually falls away in favor of “return on investment” (ROI). It is the critical measure of “dollars in” vs. “dollars out.” ROI defines the financial benefit from a specific marketing effort. It is the gold standard indicator of what’s working and/or what needs to change.

Testing, tracking and calculating ROI reveals if your marketing and advertising is successful or wasteful. In other words, it measures what you get back compared to what you put in. Plus, it’s an opportunity to do more of what’s working.

The Hawthorne Effect in the chiropractic office

The Hawthorne Effect is versatile in its applications and usefulness in most every chiropractic practice. Here are the critical management questions that guide the measure and direction of performance:

Goals — Precisely, what do you want to achieve? Objectives can be for the overall practice, for the team or department, or for an individual job function … but it must be expressed in specific and measurable values. Goals are sometimes defined in big chunks, perhaps annual or quarterly numbers, but smaller monthly, weekly or even daily goals can be more practical, and more achievable, slices.

Quantify — What are the units of measure? How do you quantify the goals, the process and/or the work? Is the unit of measure in number of patients, dollars or activity completed? For example, winning some number of patient appointments may not be as useful or specific as knowing the dollar value of the resulting case size. The meaningful business goal(s) should be expressed in units of measure that can be reasonably documented, recorded and reported.

Cornerstone metrics — These are critical, and most often it is the basic numbers that define the path to success. As a starting point, these likely include the number of new patients, patient visits, collections and referrals. What’s more, these fundamentals are easy to track.

Performance ratio — Compare goals with actual performance. Make this comparison often and early. It’s of little help to check actual performance at the end of the month only to discover that a course adjustment in week two would have made the difference between hitting or missing the mark.

Synergy and teamwork — In a tight-knit business environment — as many chiropractic offices are — collective efforts and mutual support among the staff can magnify positive results. What’s more, individuals are responsive when there is attention and interest in what they do. Individuals who are accountable tend to perform better than unsupervised individuals.

Roadblocks and fixes — What obstacles are present and/or what adjustments are needed? It’s just as useful to discover what’s not working as expected. The numbers can reveal problems to be resolved for an activity and/or for system improvement.

There may be dozens of “Hawthorne Effect” pulse points in any chiropractic office. But begin with the critical-difference indicators that are most important to near- and long-term success. These may be measures of patient care as well as the business and financial well-being of the practice.

The Hawthorne Effect in business

Without monitoring and testing, productivity, performance and goal achievement are only wishful thinking. Otherwise, there is no precise means to know if a department, a team or an individual is contributing to defined goals. There’s a certain pride — and improved performance — in the recognition of work effort and achievement, both individually and as a group.

Regardless of the label, “Hawthorne” may be one of the most versatile and valuable management tools for the success of any chiropractic office.

STEWART GANDOLF, MBA, is chief executive officer of Healthcare Success, one of the nation’s leading health care and digital marketing agencies. Over the past 20 years he has marketed and consulted for more than 1,000 health care clients, ranging from practices and hospitals to multibillion-dollar corporations. A frequent speaker, he has shared his expertise at more than 200 venues nationwide. To learn more, go to healthcaresuccess.com.