RESUMEN
BACKGROUND: Benchmarking has become very popular among managers to improve quality in the private and public sector, but little is known about its applicability in international hospital settings. PURPOSE: The purpose of this study was to evaluate the applicability of an international benchmarking initiative in eye hospitals. METHODOLOGY: To assess the applicability, an evaluation frame was constructed on the basis of a systematic literature review. The frame was applied longitudinally to a case study of nine eye hospitals that used a set of performance indicators for benchmarking. Document analysis, nine questionnaires, and 26 semistructured interviews with stakeholders in each hospital were used for qualitative analysis. FINDINGS: The evaluation frame consisted of four areas with key conditions for benchmarking: purposes of benchmarking, performance indicators, participating organizations, and performance management systems. This study showed that the international benchmarking between eye hospitals scarcely met these conditions. The used indicators were not incorporated in a performance management system in any of the hospitals. Despite the apparent homogeneity of the participants and the absence of competition, differences in ownership, governance structure, reimbursement, and market orientation made comparisons difficult. Benchmarking, however, stimulated learning and exchange of knowledge. It encouraged interaction and thereby learning on the tactical and operational levels, which is also an incentive to attract and motivate staff. PRACTICE IMPLICATIONS: Although international hospital benchmarking seems to be a rational process of sharing performance data, this case study showed that it is highly dependent on social processes and a learning environment. It can be useful for diagnostics, helping local hospitals to catalyze performance improvements.
Asunto(s)
Benchmarking , Lesiones Oculares/terapia , Hospitales Especializados/normas , Humanos , Internacionalidad , Entrevistas como Asunto , Oftalmología/normas , Estudios de Casos Organizacionales , Investigación Cualitativa , Encuestas y CuestionariosRESUMEN
PURPOSE: The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains. DESIGN/METHODOLOGY/APPROACH: In a retrospective case study an in-depth evaluation of the use of a quality cost model (QCM) and the applicability of Porter's care delivery value chain (CDVC) was performed in a specific care process: glaucoma care over the period 2001 to 2006 in the Rotterdam Eye Hospital in The Netherlands. FINDINGS: The case study shows a reduction of costs per product by increasing the number of outpatient visits and surgery combined with a higher patient satisfaction. Reduction of costs of non-compliance by using the QCM is small, due to the absence of (external) financial incentives for both the hospital and individual physicians. For CDVC to be supportive to an integrated quality and cost management the notion "patient value" needs far more specification as mutually agreed on by the stakeholders involved and related reimbursement needs to depend on realised outcomes. RESEARCH LIMITATIONS/IMPLICATIONS: The case study just focused on one specific care process in one hospital. To determine effects in other areas of health care, it is important to study the use and applicability of the QCM and the CDVC in other care processes and settings. ORIGINALITY/VALUE: QCM and a CDVC can be useful tools for hospital management to manage the outcomes on both quality and costs, but impact is dependent on the incentives in the context of the existing organisational and reimbursement system and asks for an agreed on operationalisation among the various stakeholders of the notion of patient value.
Asunto(s)
Atención a la Salud/organización & administración , Glaucoma/terapia , Estudios de Casos Organizacionales , Satisfacción del Paciente , Calidad de la Atención de Salud/organización & administración , Costos y Análisis de Costo , Recolección de Datos , Atención a la Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/organización & administración , Humanos , Países Bajos , Evaluación de Procesos, Atención de Salud/organización & administración , Indicadores de Calidad de la Atención de Salud/organización & administración , Calidad de la Atención de Salud/economía , Reembolso de Incentivo , Estudios RetrospectivosRESUMEN
BACKGROUND: The Ontario health care system is devolving planning and funding authority to community based organizations and moving from steering through rules and regulations to steering on performance. As part of this transformation, the Ontario Ministry of Health and Long-Term Care (MOHLTC) are interested in using incentives as a strategy to ensure alignment - that is, health service providers' goals are in accord with the goals of the health system. The objective of the study was to develop a decision framework to assist policymakers in choosing and designing effective incentive systems. METHODS: The first part of the study was an extensive review of the literature to identify incentives models that are used in the various health care systems and their effectiveness. The second part was the development of policy principles to ensure that the used incentive models are congruent with the values of the Ontario health care system. The principles were developed by reviewing the Ontario policy documents and through discussions with policymakers. The validation of the principles and the suggested incentive models for use in Ontario took place at two meetings. The first meeting was with experts from the research and policy community, the second with senior policymakers from the MOHLTC. Based on the outcome of those two meetings, the researchers built a decision framework for incentives. The framework was send to the participants of both meetings and four additional experts for validation. RESULTS: We identified several models that have proven, with a varying degree of evidence, to be effective in changing or enabling a health provider's performance. Overall, the literature suggests that there is no single best approach to create incentives yet and the ability of financial and non-financial incentives to achieve results depends on a number of contextual elements. After assessing the initial set of incentive models on their congruence with the four policy principles we defined nine incentive models to be appropriate for use in Ontario and potentially other health care systems that want to introduce incentives to improve performance. Subsequently, the models were incorporated in the resulting decision framework. CONCLUSION: The design of an incentive must reflect the values and goals of the health care system, be well matched to the performance objectives and reflect a range of contextual factors that can influence the effectiveness of even well-designed incentives. As a consequence, a single policy recommendation around incentives is inappropriate. The decision framework provides health care policymakers and purchasers with a tool to support the selection of an incentive model that is the most appropriate to improve the targeted performance.
Asunto(s)
Toma de Decisiones en la Organización , Programas Nacionales de Salud/economía , Planes de Incentivos para los Médicos , Reembolso de Incentivo , Análisis Costo-Beneficio , Humanos , Modelos Econométricos , Ontario , Política Organizacional , Planes de Incentivos para los Médicos/economía , Planes de Incentivos para los Médicos/organización & administración , Reembolso de Incentivo/organización & administración , Salarios y BeneficiosRESUMEN
There is increasing evidence that health care systems can create better value for money by improving performance and setting the right incentives. Worldwide this has led to an emergence of financial and non-financial incentive structures as a strategy to improve performance. The role of incentives is not only to motivate high performance through the alignment of results and rewards (financial/non-financial as well as direct/indirect) but also to enable health care providers to perform better by mitigating financial barriers that typically result from funding schemes. Various incentive structures in health care, identified in the scientific literature, are described in this article and available evidence on effectiveness and side effects is summarized. Literature shows that there is no single best approach to create an incentive yet and that the ability of financial and non-financial incentives to achieve desired results depends on a number of circumstantial elements. Several incentive schemes that can be used by health care insurers or local health authorities are discussed and concrete examples are provided. Decision-making on incentive schemes requires a careful design with the involvement of those targeted by incentives.
Asunto(s)
Atención a la Salud/economía , Asignación de Recursos para la Atención de Salud , Costo de Enfermedad , Revelación , Alemania , Humanos , Modelos Psicológicos , Motivación , Salarios y BeneficiosRESUMEN
Major reforms of the health insurance system and reimbursement systems for care providers are currently taking place in The Netherlands. These market-oriented health care reforms will transform the current central supply-driven system to a system of managed competition both among health care insurers and care providers. The reforms are not systematically linked to the discussions about quality of care and together with consumers who might be more interested in lower premiums; they offer almost no incentive for health care insurers and providers to steer on quality. Dutch policy makers should, therefore, be more explicit whether competition should take place on quality or price, and if the former is the case, additional incentives as part of the system reforms, are needed to create a business case for quality. (AU)
Asunto(s)
Reforma de la Atención de Salud , Garantía de la Calidad de Atención de Salud , Seguro de Salud , Motivación , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/organización & administración , Mecanismo de Reembolso , Países Bajos , Formulación de PolíticasRESUMEN
Major reforms of the health insurance system and reimbursement systems for care providers are currently taking place in The Netherlands. These market-oriented health care reforms will transform the current central supply-driven system to a system of managed competition both among health care insurers and care providers. The reforms are not systematically linked to the discussions about quality of care and together with consumers who might be more interested in lower premiums; they offer almost no incentive for health care insurers and providers to steer on quality. Dutch policy makers should, therefore, be more explicit whether competition should take place on quality or price, and if the former is the case, additional incentives as part of the system reforms, are needed to create a business case for quality.