Assessing the usefulness of instant feedback and the hawthorne effect: An audit of time indexes of EMS missions in Tehran

Abstract

Introduction It has been well established that if a person is aware that they are being monitored their commitment and effort will be maximised (the Hawthorne effect), which then leads to efficiency increase and optimal workflow. Objective Our aim was to evaluate the efficacy of instant feedback and the Hawthorne effect of this intervention on pre-hospital time indexes during emergency medical service (EMS) missions. Methods This is a cross-sectional auditing study on the missions of the Tehran EMS Center (performed over a 12-month period) in three phases: pre-intervention, instant feedback, and monitoring without feedback. The measured time indexes were the different parts of mission times. To collect data, a pre-prepared checklist was set up. For the first phase, data were extracted from the database of the Tehran EMS Center. In the second and third phases, the data were entered into the relevant forms for each mission by the researcher and executive colleagues. Results The data of 229,847 missions were analysed. In the instant feedback phase, compared to the pre-intervention phase, the mean activation time, response time, scene time, transfer time and hospital delay time were decreased. When we compared the mean time indexes in the monitoring phase compared to the instant feedback phase, we saw that the average activation time, response time and transfer time were increased but they were still less than that in the pre-intervention phase. However, the scene time and hospital delay time were not changed compared to the instant feedback phase but were lower than that in the pre-intervention phase. Conclusion Auditing was effective in reducing the total time of missions and this effect was largely maintained in the monitoring phase under the Hawthorne effect.