Identifying executive challenges of performance-based payment from medical and educational hospitals managers’ perspective and offering solutions in Isfahan (2018)

Abstract

Introduction: Performance-based payment is a payment model that attempts to reward the measured dimensions of performance and encourages health service providers to achieve predetermined goals by financial incentives. This study aimed to identify executive challenges of performance-based payment from medical and educational hospitals managers’ perspective and offering solutions in Isfahan 2018.
 Methods: This study was a qualitative study. Semi structured interviews were used to collect data. The research population was 11 people (the managers of educational and medical hospitals in Isfahan) who were selected purposefully. All interviews were recorded and then written on a paper. The duration of the interviews varied between 45 to 60 minutes. The data were analyzed using MAXQDA120 software and based on thematic analysis.
 Results: In this study, , regarding executive challenges, seven themes and fifteen sub-themes were obtained, including the weakness of the performance-based payment project, weakness in education and educational support, low employee participation, weakness of information and communication technology, weakness of laws and regulations, unfavorable economic conditions of the public sector, and special conditions governing public hospitals.
 
 Conclusion: performance-based payment, if implemented correctly, can lead to the improvement of quantitative and qualitative indicators related to employees’ performance. Correct implementation requires identifying challenges and obstacles and then corrective actions. This study was able to identify and present some of the operational challenges of the performance-based payment from the viewpoint of hospital managers.

Barriers in the performance-based payment in Iran health system

“…The sooner a plan is implemented without the right timing, the more likely it is to fail. [ 3 ] In a study conducted by Condo et al ., The findings showed that the development of a suitable platform in the implementation of the plan and the creation of the required capacities before the start of the plan is considered as an effective factor in the realization of the performance payment plan. [ 10 ]…”

“…In this study, it was mentioned that the lack of motivation in employees to implement a performance-based payment plan has led to employee resistance and failure of the plan. [ 3 ]…”

“…[ 1 2 ] Increasing resources and optimal allocation of health system resources are one of the major concerns of most governments, both in low-income countries and in middle- and even high-income countries. [ 3 ]…”

“…[ 6 7 ] On the other hand, staff dissatisfaction has a negative impact on patient care and consequently reduces the quality of services provided to patients, increases the length of stay of patients in the hospital, and ultimately increases costs. [ 3 ]…”

Exploring the challenges and features of implementing performance-based payment plan in hospitals: a protocol for a systematic review

“…The first large-scale PBP plan in the private sector was introduced by the Comprehensive Health Care Association in California in 2003 and still is active. Since then, PBP plans have been employed by strategic health purchasers in most of the countries in order to strengthen and reform traditional payment systems [ 6 ]. Nowadays, most organizations in charge of protecting health and Medicaid program resort to PBP plan.…”