‘Backfire examples’ from outside healthcare quality improvement
| ‘Streisand effect’—efforts to suppress information draw more attention to it. | Physicians who attempt to have a few negative reviews by patients removed from public websites risk this effect.42 |
| ‘Technological revenge effects’ | A paradigmatic example from Edward Tenner’s book on this subject43 was the proliferation of paper in the 1980s. Far from the end of paper predicted to occur with the spread of personal computers, paper consumption increased dramatically from the ease with which printing of documents and graphics could occur. |
| ‘Cobra effect’ | Financial incentives in some contexts create perverse results—for example, a bounty for dead cobras creates a market for breeding cobras and turning them in for the reward.9 |
| ‘Compensatory risk’ | Making something safer sometimes engenders riskier behaviours—for example, make cars safer and people may drive more recklessly.11 12 |
| Financial penalties for late pick-ups at daycare end up increasing the frequency of late pick-ups.44 | Since the financial penalties were not severe, parents can (subconsciously) regard arriving late as a service for which they can pay a fee. |
| Providing condoms to sex workers can increase unprotected sex.45 46 | Greater use of condoms creates a market for offering unprotected sex at a higher price (or puts pressure on sex workers to offer discounts for sex with condoms).45 46 |
| The government of Ghana doubled salaries for police officers in 2010 to mitigate petty corruption on its roads. Instead, bribes increased, not just compared with before but also to a neighbouring where the same truck drivers travelled.47 | This result likely reflects the need for other concomitant interventions, such as increased monitoring for corruption and strict enforcement of penalties for accepting bribes. |
| 'Scared Straight’, a programme aimed at deterring criminal behaviour among youth by exposing them to the harsh realities of prison leads to more offending behaviour compared with doing nothing at all.48 | The mechanism remains unclear, but may include ‘peer contagion theory’ (law-abiding kids influenced by more deviant peers) and emboldening some kids by creating the impression that inmates they see on their visit are just ‘losers who got caught’.49 |
| Disclosing conflicts of interest may not only fail to mitigate bias but actually increase it. | Probably several mechanisms, including overwhelming recipients of disclosures with so much information that they miss important conflicts and feelings of ‘moral license’ among those disclosing conflicts because advisees ‘have been warned’.50 51 |