BPTs Best Practice Tariffs () BQS Bundesgeschaftstelle Qualitatssicherung: Insitut fur Qualitat & Patientensicherheit (National Institute for Quality and Patient Safety in ) CAUTI Catheter Associated Urinary Tract Infection CLABSI Central Line Associated Bloodstream Infection Commission Australian Commission on Safety and Quality in Health Care CCGs Clinical Commission Groups CQUIN Commissioning for Quality Innovation payment framework () HAI Healthcare Associated Infection DMPs Disease Management Programs () HRGs Healthcare Resource Groups (in the UK National Health Service, HRGs are a grouping consisting of patient events that have been judged to consume a similar level of resource) IHPA Pricing Authority IOM JWP Joint Working Party: Safety and Quality KP Kaiser Permanente health system (US) NHS National Health Service (publicly funded health care system of the ) NICE National Institute for Health and Clinical Excellence OECD Organisation for Economic Cooperation and Development PbR Payment by Results () PHI Private Health Insurance PHQID Premier Hospital Quality Improvement Demonstration (US) P4P Pay for Performance SHI Statutory health insurance (SHI)
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.