Journal of Qualitative Research in Health Sciences

Document Type : Original Article

Authors

1 Associate Professor in Health Services Management, Health Management and Economics Research Center, Faculty of Management and Medical Information, Isfahan, Iran

2 Professor in Health Services Management, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

3 PhD Student in Nursing, Department of Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

4 PhD Student in Health Services Management, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Introduction: The implementation of the performance-based payment scheme sparked a hope that the changes in the payment of financial rewards to employees in a fair manner and based on their performance can increase employees’ motivation and job satisfaction. Accordingly, this study investigated the consequences of performance-based payments and regulatory schemes from the perspective of health managers in selected educational and medical centers in Isfahan.
Methods: This qualitative study was conducted using a phenomenological approach. The data in this study were collected through in-depth interviews with eleven experts working in the management divisions of hospitals and central offices as well as the staff and faculty members of Isfahan University of Medical Sciences. The respondents were selected using purposive sampling. The collected data were analyzed using the content analysis method.
Results: The consequences of performance-based payments were explained by one main theme (the consequences of implementing the performance-based payment plan in the health system) and four subthemes. Besides, one main theme (the general national and professional factors of the health system affecting the regulatory schemes) and five subthemes accounted for regulatory schemes.
Conclusion: Payment regulatory schemes should be formulated effectively to address the problems associated with the current payment system so that the establishment of a performance-based payment system can serve as a mechanism to achieve this goal and a basis for reforming the existing payment systems.

Keywords

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    1. Hope J, Player S. Beyond performance management: Why, when, and how to use 40 tools and best practices for superior business performance. Massachusetts, USA: Harvard Business Press; 2012.
    2. Raeisi P, Alikhani M, Mobinizadeh MR. Fee for service (FFS) payment on the basis of performance in Hasheminejad hospital, Tehran. Journal of Healthcare Management (Journal of Health System). 2010; 2(1-2):27-36. [In Persian].
    3. Corley EA, Bozeman B, Zhang X, Tsai C-C. The expanded scientific and technical human capital model: The addition of a cultural dimension. The Journal of Technology Transfer. 2019; 44(3):681-99. doi: 10.1007/s10961-017-9611-y.
    4. Pifeh A, Righi R, Zarei H, Soofi F. Investigating the effectiveness of implementing performance-based payment plan on Sistan and Baluchestan university of medical sciences. Journal of Health Accounting. 2019; 8(1):70-88. [In Persian].
    5. Bastani P, Ahmadzadeh MS, Abbasi Larki R, Khammarnia M. The viewpoints of hospitals personnel regarding performance-based payment plan at Shiraz university of medical sciences in 2015. Journal of Rafsanjan University of Medical Sciences and Services. 2017;15(10):943-54. [In Persian].
    6. RezanjadT, Manourian A, Abbasi, T. Identifying and explaining the obstacles of performance-based payments in public organizations. Journal of Research in Human Resources Management. 2016; 8(3): 109-33. [In Persian].
    7. Dehghan N, Gouchani SM, Alizadeh H. Designing the Local model of effective factors on reward distribution in AJA khatam al anbia air defense sub base. Military Management. 2015; 14(56):51-77.
    8. Mazurek MJ. Practitioner application: Does patient safety pay? evaluating the association between surgical care improvement project performance and hospital profitability. J Healthc Manag. 2019; 64(3):155-6. doi: 10.1097/JHM-D-19-00051. 
    9. Mohamadi Khoshoui R, Salehi S, Saeedian N. A qualitative investigation into components of patient safety organizational culture in the medical education centers: A medical errors management approach. Journal of Qualitative Research in Health Sciences. 2020; 8(4):49-58. [In Persian].
    10. Rich EC, Lake TK, Valenzano CS, Maxfield MM. Paying the doctor: Evidence-based decisions at the point-of-care and the role of fee-for-service incentives. J Comp Eff Res. 2013; 2(3):235-47. doi: 10.2217/cer.13.26.
    11. Mehrtak M, Hozoori MJ, Mogharrab SM, Jannati A, Darvish H, Saadati M. Barriers to implementing performance-based budgeting at Iranian universities of medical sciences: A qualitative study. J Qual Res Health Sci. 2016; 5(4):363-75. [In Persian].
    12. Yıldırım A, Şimşek H. Qualitative research methods in social sciences. Ankara: Seçkin Publishing; 2005. P. 24-32.
    13. Keyvanara M, Karimi S, Khorasani E. Jafarian jazi M. Challenges resulting from healthcare induced demand: Aqualitative study. Health Inf Manage. 2013; 10(4):538-48. [In Persian].
    14. Khorasani E, Keyvanara M, Karimi S, Jafarian Jazi M. The Role of patients in induced demand from experts’ perception: A qualitative study. Journal of Qualitative Research in Health Sciences. 2014; 2(4):336-45. [In Persian].
    15. Nemat Bakhsh M, Thabit B, Rezaei P, Shokrchizadeh A, Naji H. A survey of medical school faculty members of the university in the conservative medical education at teaching hospitals. Strides in Development of Medical Education. 2006; 3(2):69-77.
    16. Bahadori MK, Farzaneh A, Ibrahimipour H. The challenges of supervision on providing health services from the viewpoint of the insurer: A qualitative study. International Journal of Collaborative Research on Internal Medicine & Public Health. 2012; 4(9): 1673-85. [In Persian].
    17. Bradley S, Kamwendo F, Masanja H, De Pinho H, Waxman R, Boostrom C, et al. District health managers’ perceptions of supervision in Malawi and Tanzania. Human Resources for Health. 2013; 11(1):43. doi: 1186/1478-4491-11-43.
    18. Baker G, Carter B. The evolution of pay for performance models for rewarding providers: Case Studies in Health Plan Pay-for-Performance Washington, DC: Atlantic Information Services; 2004.
    19. Casalino L, Gillies RR, Shortell SM, Schmittdiel JA, Bodenheimer T, Robinson JC, et al. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. Jama. 2003; 289(4):434-41. doi: 10.1001/jama.289.4.434.
    20. Dudley RA, Rosenthal MB. Pay for performance: A decision guide for purchasers. Agency for Healthcare Research and Quality. 2006; 6:0047.
    21. Steiger B. Poll finds physicians very wary of pay-for-performance programs. Physician Exec. 2005; 31(6):6-11. PMID: 16382644.
    22. Armstrong M, Baron A. Performance management. In Dransfild R (ed), Human Resource Management. Oxford: Heinemann Educational Publishers. 2000; P. 69-84.
    23. Tavakkoli MR, Karimi S, Jabbari A, Javadi M. A survey of the strengths of the performance-based scheme in selected teaching hospitals of Isfahan, Iran, in 2014: A qualitative study. J Qual Res Health Sci. 2016; 5(1):46-55. [In Persian].
    24. Jabari AR, Karimi S, Javadi M, Tavakkoli MR. Economic reform strategies to improve the performance of surveillance and infrastructure for implementation of new fee for service guidelines, 2014: A qualitative study. Journal of Qualitative Research in Health Sciences. 2017; 6(2):112-23. [In Persian].