5.2 Key aspects of schemes ‘successful’ There are some common traits of P4P schemes demonstrating a desirable effect. These include inter alia: engagement of key stakeholders in the design of schemes use of reliable data and metrics that are by the those whose ‘accepted’ behaviour is being influenced adaptation to local requirements and context the targeted activity not excessively dependent on collaboration and team work. 5.2.1 Comparing the Advancing Quality (UK) with PHQID (US) schemes Comparing the evaluation of the Premier Hospital Quality Improvement Demonstration (PHQID) project with the (AQ) scheme ‘Advancing Quality’ provides some useful insights. Both are fundamentally similar, and both function on a basis. PHQID evaluations have repeatedly failed to ‘tournament’ demonstrate outcome benefits9-12 whereas positive results associated with the UK scheme are emerging.13-14 What are the key differences? Firstly, the incentives in AQ are larger and distributed among a wider spread of high performing hospitals. Whether this is the key is debatable as there is no clear consensus in the literature. Second is the way in which participants implemented and applied the schemes. From the outset, CEOs of AQ participating hospitals agreed that bonuses would not be taken as personal income but be allocated “would internally to clinical teams whose performance had earned the bonus” 13(p1822). The bonuses were re-invested in quality improvement activity such as: Employment of specialist nurses Development of new or improved data collection systems for regular feedback to clinical personnel about local performance Moreover, despite the competitive nature of the scheme, staff from all participating hospitals in northern England regularly met face-to-face to discuss issues and share learnings.13 No such re-investment of bonuses, or collaboration with peers (with the exception of was evident in the ‘webinars’) PHQID scheme. It could be argued that financial incentives alone are perhaps not sufficient unless coupled with other interventions which tap into other motivational factors listed in section 5.1.1. Indeed, financial bonuses could be seen as a facilitator of these. It is clear that the success of financial incentive schemes in complex healthcare organisations depends strongly on implementation and application, as well as their design and theoretical underpinnings.
5.2 Key aspects of ‘successful’ schemes There are some common traits of P4P schemes demonstrating a desirable effect. These include inter alia: engagement of key stakeholders in the design of schemes use of reliable data and metrics that are ‘accepted’ by the those whose behaviour is being influenced adaptation to local requirements and context the targeted activity not excessively dependent on collaboration and team work. 5.2.1 Comparing the Advancing Quality (UK) with PHQID (US) schemes Comparing the evaluation of the Premier Hospital Quality Improvement Demonstration (PHQID) project with the ‘Advancing Quality’ (AQ) scheme provides some useful insights. Both are fundamentally similar, and both function on a ‘tournament’ basis. PHQID evaluations have repeatedly failed to demonstrate outcome benefits9-12 whereas positive results associated with the UK scheme are emerging.13-14 What are the key differences? Firstly, the incentives in AQ are larger and distributed among a wider spread of high performing hospitals. Whether this is the key is debatable as there is no clear consensus in the literature. Second is the way in which participants implemented and applied the schemes. From the outset, CEOs of AQ participating hospitals agreed that bonuses would not be taken as personal income but “would be allocated internally to clinical teams whose performance had earned the bonus” 13(p1822). The bonuses were re-invested in quality improvement activity such as: Employment of specialist nurses Development of new or improved data collection systems for regular feedback to clinical personnel about local performance Moreover, despite the competitive nature of the scheme, staff from all participating hospitals in northern England regularly met face-to-face to discuss issues and share learnings.13 No such re-investment of bonuses, or collaboration with peers (with the exception of ‘webinars’) was evident in the PHQID scheme. It could be argued that financial incentives alone are perhaps not sufficient unless coupled with other interventions which tap into other motivational factors listed in section 5.1.1. Indeed, financial bonuses could be seen as a facilitator of these. It is clear that the success of financial incentive schemes in complex healthcare organisations depends strongly on implementation and application, as well as their design and theoretical underpinnings.
Supplementary-Briefing-and-literature-update-Joint-Working-Party-Safety-and-Quality.docx