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Title: Identification of hospital pay for performance schemes' theoretical frameworks, design characteristics, factors potentially influencing success and development of reporting guidelines : a mixed-method study
Author: Car, Mate
ISNI:       0000 0004 7656 9682
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2016
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Background: Pay for performance is increasingly being introduced into health systems. Previous research found conflicting results regarding the effectiveness of pay for performance. Objectives: In this thesis, I focus on pay for performance for hospitals as institutions and aimed to understand: (a) how and why pay for performance produces its effects, (b) what are the mechanisms by which pay for performance is believed to result in its intended outcomes and (c) to develop a framework for reporting of hospital pay for performance incentive schemes. Methods: Drawing on the principles of realist review, I collected and summarised existing literature on pay for performance. Results: Analysing 143 papers, I found pay for performance is an umbrella term for a multitude of interventions that differ significantly in their motivations, design used and outcome expectations. The number of factors identified to influence pay for performance across many studies was greater than reported by any single study, suggesting an unawareness of factors or else inconsistent reporting of important factors which affect results and their interpretation. I discovered a number of context-mechanism-outcome configurations for performance incentive designs. I propose a set of reporting guidelines to improve the quality of reporting of research on pay for performance in hospitals. Conclusion: Pay for performance in the broadest sense represents paying to encourage a specific performance pattern. Using this realisation and comparing to conventional payment systems, it is evident that even they encourage performance patterns. Pay for performance is not the perfect answer for every issue, but needs to be considered as one of the tools to achieve policy objectives.
Supervisor: Majeed, Azeem ; Harris, Matthew Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral