Search This Blog

Wednesday, September 11, 2013

Pay-for-Performance - An Opportunity to Improve

Dr. Les Vertesi is the Executive Director of the British Columbia Health Services Purchasing Organization.

For many people, ‘Pay for Performance’ (P4P) implies commission-like payments such as those used in sales, but in Canadian health care it means nothing like that.  BC’s version of ED P4P paid money to hospitals, never to individuals.  Since hospitals were expected to invest all of the money earned and possibly some of their own as well, the money never really acted as a reward but as a way of monitoring success, and supporting the cost of the innovations created by their staff.   In other words, it was a way of acknowledging that change costs money but also that spending would be done more carefully if hospitals and front-line staff were invested in the choices and shared in the risk of success or failure.

For government, the assurance that they would not have to pay for measures that were not successful was a major motivating factor.   For front-line staff, it was their ability to be involved in the improvement process and in helping ensure its success.   The real reward, in other words, was never the money (since it was all reinvested) but the opportunity to improve the satisfaction of front-line ED staff by giving them the ability to control their environment and provide better patient access.   In order to maintain this motivation, all the money had to remain under the control of the hospital and its staff rather than the Health Authority.  Experience showed that those hospitals that were able to maintain this principle over time showed the best success.
* Watch the video on Pay-for-Performance, part of the Health Council of Canada's Wait Times series.

No comments:

Post a Comment