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Invited Commentary
September 2014

The Need for Speed—Can Quality and Efficiency Coexist?

Author Affiliations
  • 1Surgical Intensive Care Unit, Trauma Service, Cottage Health System, Santa Barbara Cottage Hospital, Santa Barbara, California
JAMA Surg. 2014;149(9):925. doi:10.1001/jamasurg.2014.1201

Using financial incentives to improve efficiency is not new. The business world routinely uses this. A quotation often attributed to Peter Drucker1 comes to mind: “What’s measured improves.” I prefer to think of this as “people will work faster if you pay them to work faster.” This is an effective strategy for industry. Moving an assembly line faster results in an increased but acceptable rate of defective widgets produced. While throwing more of these away may work for industry, I have reservations about applying this approach to medicine, where there is a zero tolerance for the defects we surgeons know as complications.

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