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