Explaining performance in health care: How and when top management competencies make the difference

Vainieri, Milena; Ferrè, Francesca; Giacomelli, G.; Nuti, Sabina

doi:10.1097/hmr.0000000000000164

Cited by 69 publications

(68 citation statements)

References 37 publications

(51 reference statements)

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“…Increased transparency, and a common new language that enables enhanced supervision, show that PRG-based payments worked as intended at the organizational level: these are wellknown important tools used by managers to change behavior in organizations. [34][35][36] In the Israeli PRG case, these are tools to communicate the new economic incentives to surgical ward directors aiming to change their decision-making and behavior in line with the CEOs' and hospital's new objectives. Similarly, in Finland 37 and Canada, 20 the engagement of physicians in the implementation of DRGs depended much on transparency.…”

Section: Discussionmentioning

confidence: 99%

Effects of Activity-Based Hospital Payments in Israel: A Qualitative Evaluation Focusing on the Perspectives of Hospital Managers and Physicians

Waitzberg

Quentin

Daniels

et al. 2020

Int J Health Policy Manag

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Background: Since 2010, Israel has expanded the adoption of procedure-related group (PRG) based payments for hospitals. While there is a rich quantitative literature that assesses the effects of payment reforms on efficiency or quality of care, very few qualitative studies have focused on the impacts of diagnosis-related group (DRG)-like payments on hospitals from the perspective of hospital workers as change agents. Methods: We used a qualitative, thematic analysis based on 33 semi-structured in-depth interviews with chief executive officers (CEOs), chief financial officers (CFOs), ward directors and physicians conducted in five public hospitals in Israel, sampled by maximum variation according to hospital characteristics. Results: Interviewees reported that the payment reform led to organizational changes such as increased transparency and enhanced supervision. Interviewees also reported several actions in response to the economic incentives of PRGbased payment. These included (1) shifting activities to afterhours and using operating rooms (ORs) more efficiently to enable increased surgical volumes; (2) reducing costs by shortening lengths of stay and increasing cost-consciousness in procurement; and (3) increasing revenues by improving coding and selecting procedures. Moderating factors reduced the effects of the reform. For example, organizational factors such as the public nature of hospitals or the (un)availability of healthcare resources did not always allow hospitals to increase the number of cases treated. Also, conflicting incentives such as multiple payment mechanisms or underpricing of procedures blurred the incentives of the reform. Finally, managers and physicians have many other considerations that outweigh the economic ones. Conclusion: PRG payments affected the organizational dynamics of hospitals and changed decision-making about admission and treatment policies. However, such effects were moderated by many other factors that should be considered when shaping and analyzing hospital payment reforms.

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Section: Discussionmentioning

confidence: 99%

Effects of Activity-Based Hospital Payments in Israel: A Qualitative Evaluation Focusing on the Perspectives of Hospital Managers and Physicians

Waitzberg

Quentin

Daniels

et al. 2020

Int J Health Policy Manag

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“…The results underlined the importance for organizations to share their goals, mission, and values [31]. In fact, a systematic information sharing process provided by top management (regarding, for example, goals, performance, and organizational structure) seems to be an effective strategy to engage employees [43] and promote well-being and health in the workplace. Results underlined the important role of job resources that are mainly responsible for motivational processes, within the JD-R theory [6].…”

Section: Discussionmentioning

confidence: 99%

The Evaluation of Organizational Well-Being in An Italian Teaching Hospital Using the ANAC Questionnaire

Cortese

Emanuel

Colombo

et al. 2019

IJERPH

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In Italy, the Italian National Anti-Corruption Authority (Autorità Nazionale Anti-corruzione—ANAC) has developed a questionnaire to assess the organizational well-being of employees within public agencies. The study aimed to explore the relationship among variables in the ANAC questionnaire: Several job resources (lack of discrimination, fairness, career and professional development, job autonomy, and organizational goals’ sharing) and outcomes of well-being at work, such as health and safety at work and sense of belonging. The research was carried out among workers in an Italian hospital in Northwest Italy (N = 1170), through an online self-report questionnaire. Data were grouped into two job categories: Clinical staff (N = 939) and non-clinical staff (N = 231). The hypothesized model was tested across the two groups through multi-group structural equation modeling. Results showed that health and safety at work and sense of belonging had significant positive relationships with the other variables; some differences emerged between the determinants of the two outcomes and among groups. The study aims to identify some reflections and suggestions regarding the assessment of well-being in the health care sector; implications for practice are identified to promote organizational well-being and health in organizations.

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“…In this sense, the controllability principle for GMs can be substituted by the capacity to communicate to their staff the goals to be pursued. 63 The communication can be eased if all the actors are familiar with the indicators and thus, a high number of indicators seems to be a good strategy to increase overall performance of the health care system.…”

Section: Discussionmentioning

confidence: 99%

Insights on the effectiveness of reward schemes from 10‐year longitudinal case studies in 2 Italian regions.

Vainieri

Lungu

Nuti

2018

Health Planning & Management

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SummaryBackgroundPay for performance (P4P) programs have been widely analysed in literature, and the results regarding their impact on performance are mixed. Moreover, in the real‐life setting, reward schemes are designed combining multiple elements altogether, yet, it is not clear what happens when they are applied using different combinations.ObjectivesTo provide insights on how P4P programs are influenced by 5 key elements: whom, what, how, how many targets, and how much to reward.MethodsA qualitative longitudinal analysis of 10 years of P4P reward schemes adopted by the regional administrations of Tuscany and Lombardy (Italy) was conducted. The effects of the P4P features on performance are discussed considering both overall and specific indicators.ResultsBoth regions applied financial reward schemes for General Managers by linking the variable pay to performance. While Tuscany maintained a relatively stable financial incentive design and governance tools, Lombardy changed some elements of the design and introduced, in 2012, a P4P program aimed to reward the providers. The main differences between the 2 cases regard the number of targets (how many), the type (what), and the method applied to set targets (how).ConclusionConsidering the overall performance obtained by the 2 regions, it seems that whom, how, and how much to reward are not relevant in the success of P4P programs; instead, the number (how many) and the type (what) of targets set may influence the performance improvement processes driven by financial reward schemes.

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Explaining performance in health care: How and when top management competencies make the difference

Cited by 69 publications

References 37 publications

Effects of Activity-Based Hospital Payments in Israel: A Qualitative Evaluation Focusing on the Perspectives of Hospital Managers and Physicians

Effects of Activity-Based Hospital Payments in Israel: A Qualitative Evaluation Focusing on the Perspectives of Hospital Managers and Physicians

The Evaluation of Organizational Well-Being in An Italian Teaching Hospital Using the ANAC Questionnaire

Insights on the effectiveness of reward schemes from 10‐year longitudinal case studies in 2 Italian regions.

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