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Success tends to increase and failure tends to decrease the chances of future success. We show that this impact of past outcomes can change how diagnostic success or failure are regarding the competence of an individual or a firm. Succeeding under adverse circumstances is especially impressive when initial failure reduces the chances of success more for low-quality agents than for high-quality agents. Succeeding after initial failure (being a ”successful underdog”) can also indicate higher expected quality than succeeding twice if initial success increases the chances of success of all agents to a high level. In different circumstances, the outcome after success can be especially informative about quality, implying that failing after an initial success (a ”one-hit wonder”) indicates lower quality than failing twice does. We find effects consistent with our model in data on Canadian professional hockey players and on data from the Music Lab experiment: initial failure combined with eventual success is associated with high quality. The results help to clarify when failure should be attributed to the person in charge or to the situation, when underdogs and individuals who overcome adversity are especially impressive, and when a na¨ıve ”more is better” heuristic for evaluating performance can be misleading.

© 2022, INFORMS

In Shared Medical Appointments (SMAs), patients with similar conditions meet the physician together and each receives one-on-one attention. SMAs can improve outcomes and physician productivity. Yet privacy concerns have stymied adoption. In physician-deprived nations, patients’ utility from improved access may outweigh their disutility from loss of privacy. Ours is to our knowledge the first SMA trial for any disease, in India, where doctors are scarce. In a 1,000-patient, single-site, randomized controlled trial at Aravind Eye Hospital, Pondicherry, we compared SMAs and one-on-one appointments, over four successive visits, for patients with glaucoma. We examined patients’ satisfaction, knowledge, intention-to-follow-up, follow-up rates, and medication compliance rates (primary outcomes) using intention-to-treat analysis. Of 1,034 patients invited between July 12, 2016 – July 19, 2018, 1,000 (96.7%) consented to participate, and were randomly assigned to either SMAs (N_SMA=500) or one-on-one appointments (N_1-1=500). Patients who received SMAs showed higher satisfaction (Mean_SMA=4.955 (SD 0.241), Mean_1-1=4.920 (SD 0.326); difference in means 0.035; 95% CI, 0.017-0.054, p=0.0002) and knowledge (Mean_SMA=3.416 (SD 1.340), Mean_1-1=3.267 (SD 1.492); difference in means 0.149; 95% CI, 0.057–0.241, p=0.002) than patients who received one-on-one appointments. Across conditions, there was no difference in patients’ intention-to-follow-up (Mean_SMA=4.989 (SD 0.118), Mean_1-1=4.986 (SD 0.149); difference in means 0.003; 95% CI, -0.006–0.012, p=0.481) and actual follow-up rates (Mean_SMA=87.5% (SD 0.372), Mean_1-1=88.7% (SD 0.338); difference in means -0.012; 95% CI, -0.039–0.015, p=0.377). Patients who received SMAs exhibited higher medication compliance rates (Mean_SMA=97.0% (SD 0.180), Mean_1-1=94.9% (SD 0.238); difference in means 0.020; 95% CI, 0.004–0.036, p=0.013). SMAs improved satisfaction, learning, and medication compliance, without compromising follow-up rates or measured clinical outcomes. Peer interruptions were negatively correlated with patient satisfaction in early-trial SMAs and positively correlated with patient satisfaction in later-trial SMAs. The trial was registered with Clinical Trials Registry of India with reference no. REF/2016/11/012659 and registration no. CTRI/2018/02/011998.

©2023 Sönmez et al.