Implementing hospital pay-for-performance: Lessons learned from the French pilot program. Issue 4 (April 2017)

• Record Type: Journal Article
• Authors: Girault, Anne; Bellanger, Martine; Lalloué, Benoît; Loirat, Philippe; Moisdon, Jean-Claude; Minvielle, Etienne
• Is Part Of: Health policy. Volume 121:Issue 4(2017)
• Page Start: 407
• Page End: 417
• Publication Date: 2017-04
• Subjects: Pay for performance -- Qualitative evaluation -- Incentive -- Implementation; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2017.01.007
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: Hospital leaders were mostly positive about P4P in general. They reported a good knowledge of the French pilot program. The frontline staff remained mostly unaware of the program's existence. Information dissemination about the program was limited within hospitals. Gaps in program awareness may pose an important challenge to P4P efficacy. Abstract: Despite a wide implementation of pay-for-performance (P4P) programs, evidence on their impact in hospitals is still limited. Our objective was to assess the implementation of the French P4P pilot program (IFAQ1) across 222 hospitals. The study consisted of a questionnaire among four leaders in each enrolled hospital, combined with a qualitative analysis based on 33 semi-structured interviews conducted with staff in four participating hospitals. For the questionnaire results, descriptive statistics were performed and responses were analyzed by job title. For the interviews, transcripts were analysed using coding techniques. Survey results showed that leaders were mostly positive about the program and reported a good level of awareness, in contrast to the frontline staff, who remained mostly unaware of the program's existence. The main barriers were attributed to lack of clarity in program rules, and to time constraints. Different strategies were then suggested by leaders. The qualitative results added further explanations for low program adoption among hospital staff, so far. Ultimately, although paying for quality is still an intuitive approach; gaps in program awareness within enrolled hospitals may pose an important challenge to P4P efficacy. Implementation evaluations are therefore necessary for policymakers to better understand P4P adoption processes among hospitals.