More than a score: a qualitative study of ancillary benefits of performance measurement

Powell, Adam A.; White, Katie; Partin, Melissa R.; Halek, Krysten; Hysong, Sylvia J.; Zarling, Edwin J.; Kirsh, Susan; Bloomfield, Hanna E.

doi:10.1136/bmjqs-2013-002149

Cited by 14 publications

(27 citation statements)

References 32 publications

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“…There is plenty of evidence of PMs' powerful role in improving healthcare, including unintended positive benefits. 36 The intent with this critique is to make them even better positioned for the next generation.…”

Section: Next Steps For the Partnershipmentioning

confidence: 99%

Effects of Performance Measure Implementation on Clinical Manager and Provider Motivation

et al. 2014

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Section: Next Steps For the Partnershipmentioning

confidence: 99%

Effects of Performance Measure Implementation on Clinical Manager and Provider Motivation

et al. 2014

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“…Table 1 provides details related to the time period of program implementation since the inception of P4P in the early 2000s (early, evolving, and routinization), as well as the program design as described by the authors of each article. Nine articles were focused on studies based in the United Kingdom, 34,35,39,40,42,43,[45][46][47] 7 articles in the United States, 33,37,38,48,49,51,52 1 article each in Tanzania, 36 Malawi, 44 France, 50 and the Netherlands. 41 Twelve articles focused on physicians, nurses, and health care professionals, 5 articles focused on physicians, one of which also included practice executives, 2 articles focused on practice executives/leaders, and 1 article focused on nonphysician health care professionals.…”

Section: Resultsmentioning

confidence: 99%

“…Competition itself was noted to be a strong positive driver of behavior change that did not appear to impact the health care professionals' intrinsic motivation. 33,34,37,38,40,44,49,51 Competition was noted, both within a clinic and across clinical settings, to have a strong impact on participants. "I think that GPs, and doctors by nature are competitive, and so one wants to get all the brownie points that one can .…”

Section: Alignment With Professional Values and Intrinsic Motivationmentioning

confidence: 99%

Health Care Professionals’ Perceptions of Pay-for-Performance in Practice: A Qualitative Metasynthesis

Martin

Jones

Miller

et al. 2020

INQUIRY

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Incentive-based pay-for-performance (P4P) models have been introduced during the last 2 decades as a mechanism to improve the delivery of evidence-based care that ensures clinical quality and improves health outcomes. There is mixed evidence that P4P has a positive effect on health outcomes and researchers cite lack of engagement from health care professionals as a limiting factor. This qualitative metasynthesis of existing qualitative research was conducted to integrate health care professionals’ perceptions of P4P in clinical practice. Four themes emerged during the research process: positive perceptions of the value of performance measurement and associated financial incentives; negative perceptions of the performance measurement and associated financial incentives; perceptions of how P4P programs influence the quality/appropriateness of care; and perceptions of the influence of P4P program on professional roles and workplace dynamics. Identifying factors that influence health care professionals’ perceptions about this type of value-based payment model will guide future research.

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“…Novel methods of engaging clinical staff in activities that support health promotion have an opportunity to enhance provider feelings of impact on patient health. Similarly, performance feedback for initiatives has been reported to increase clinical staff pride in their personal or their practice’s achievement [ 25 ]. The VP transformation to better health coordinated with the provider behavior transformation to increased smoker referrals is a visual form of performance feedback that taps into providers’ intrinsic motivation of effective patient care.…”

Section: Discussionmentioning

confidence: 99%

Virtual Patient Technology: Engaging Primary Care in Quality Improvement Innovations

Blok¹,

May²,

Sadasivam³

et al. 2017

JMIR Med Educ

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BackgroundEngaging health care staff in new quality improvement programs is challenging.ObjectiveWe developed 2 virtual patient (VP) avatars in the context of a clinic-level quality improvement program. We sought to determine differences in preferences for VPs and the perceived influence of interacting with the VP on clinical staff engagement with the quality improvement program.MethodsUsing a participatory design approach, we developed an older male smoker VP and a younger female smoker VP. The older male smoker was described as a patient with cardiovascular disease and was ethnically ambiguous. The female patient was younger and was worried about the impact of smoking on her pregnancy. Clinical staff were allowed to choose the VP they preferred, and the more they engaged with the VP, the more likely the VP was to quit smoking and become healthier. We deployed the VP within the context of a quality improvement program designed to encourage clinical staff to refer their patients who smoke to a patient-centered Web-assisted tobacco intervention. To evaluate the VPs, we used quantitative analyses using multivariate models of provider and practice characteristics and VP characteristic preference and analyses of a brief survey of positive deviants (clinical staff in practices with high rates of encouraging patients to use the quit smoking innovation).ResultsA total of 146 clinical staff from 76 primary care practices interacted with the VPs. Clinic staff included medical providers (35/146, 24.0%), nurse professionals (19/146, 13.0%), primary care technicians (5/146, 3.4%), managerial staff (67/146, 45.9%), and receptionists (20/146, 13.7%). Medical staff were mostly male, and other roles were mostly female. Medical providers (OR 0.031; CI 0.003-0.281; P=.002) and younger staff (OR 0.411; CI 0.177-0.952; P=.038) were less likely to choose the younger, female VP when controlling for all other characteristics. VP preference did not influence online patient referrals by staff. In high-performing practices that referred 20 or more smokers to the ePortal (13/76), the majority of clinic staff were motivated by or liked the virtual patient (20/26, 77%).ConclusionsMedical providers are more likely motivated by VPs that are similar to their patient population, while nurses and other staff may prefer avatars that are more similar to them.

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More than a score: a qualitative study of ancillary benefits of performance measurement

Cited by 14 publications

References 32 publications

Effects of Performance Measure Implementation on Clinical Manager and Provider Motivation

Effects of Performance Measure Implementation on Clinical Manager and Provider Motivation

Health Care Professionals’ Perceptions of Pay-for-Performance in Practice: A Qualitative Metasynthesis

Virtual Patient Technology: Engaging Primary Care in Quality Improvement Innovations

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