Pay for Quality

KCE Reports 118 Pay for Quality 153
The idea of ‘ranking’ such as hospitals is not supported by the majority of stakeholders.
It is said that there is no evidence that this kind of information would be of additional
benefit to the patient. In some cases it can have a pervert effect, giving them
dissymmetric and biased information.
Overall it is assumed that quality should be defined in agreement with patient
representatives.
8.2.7.4 Mandatory or voluntary participation
Many stakeholders subscribe to the principle of voluntary participation to pay for quality
programmes, at least as a first step towards the implementation of such programmes.
They evoked various reasons for it including e.g. increased chances for success (strongly
related to changes in attitudes), improved awareness on the importance of quality in
providers and a greater chance for the acceptance of the programme. In contrast to
stakeholders that favour voluntary participation other stakeholders defend the idea of
mandatory participation mainly because of methodological requirements. However, the
latter stakeholders also admitted it would be very difficult to gain widespread
acceptance for mandatory participation. Some softened their opinion in proposing the
mandatory participation as a final step of implementation or with a self definition of own
goals.
8.2.7.5 Staged approach of implementation
It was commonly declared that a progressive and staged approach should be followed to
implement P4Q programmes. The main reason is the time required to change attitudes,
develop buy-in and to increase motivation.
Some stakeholders proposed to start on a local basis in those domains were success is
not too difficult to achieve which would potentially result into high participation rates in
providers and patients. Critical success factors for the implementation of pay for quality
programmes are defined as: clear role definition, responsibilities and tasks of the parties
involved, the development of a common methodology for the design, evaluation and
validation of those programmes. In this context, some stakeholders referred to the
methodology of clinical trials and action research. Baseline evaluations and periodic
assessments were also mentioned. In this way, Belgian stakeholders comply with the
international requirements for a staged implementation of pay for quality programmes.
8.2.7.6 Communication to the providers
Clear communication using professional tools is considered necessary to reach the
professionals involved. It is recommended that any confusion with programmes that are
badly perceived (e.g. accreditation, feedback) is to be avoided.
Some stakeholders stressed the importance of a clear definition of objectives and
standards and of the use of evidence based data.
8.2.7.7 Stand alone or embedded in a broader quality project
It is considered important that pay for quality programmes become part of a global
vision and plan on quality improvement of the Belgian health care system. Stakeholders
stressed that coordination is required to ensure a common approach of the
programmes.