Pay for Quality

KCE Reports 118 Pay for Quality 13
2.1.5 Conducting a systematic review of Belgian P4Q initiatives, and evaluating
the feasibility of P4Q implementation, based on the comparison of
current Belgian policy vs. findings from literature.
The output of the systematic review on P4Q (see chapter 3 and 4) nor an additional
search strategy using Dutch and French entry terms within the predefined search string
identified any Belgian study.
These limitations highlighted the need to collect the information as broadly as possible
on a local scale by direct contact of all stakeholders involved. Because interviews of
forty persons were planned as part of the chapter 8 data collection, these meetings
were used as an opportunity to seek additional information on existing (P4)Q initiatives.
They were asked to refer the research team to other persons involved in (P4)Q
initiatives to provide additional information. These persons were contacted by phone
and email, using a standardized template to collect (P4)Q initiative data. We write on
purpose “(P4)Q” because, as will be shown in Chapter 7, the large majority of the
current Belgian initiatives do focus on quality improvement, however do not apply P4Q.
Nevertheless, a number of programmes did involve a kind of financial incentive. But this
incentive wasn’t in any programme directly related to the measured performance of
participants with regard to predefined quality targets. In Chapter 7 we provide an
overview of all Belgian quality initiatives that were mentioned by the experts. These
programmes provide possibilities to develop pay for quality initiatives, as will be further
analyzed in section 7.2.
The feasibility study makes use of the empirically revised conceptual framework
(Chapter 5) to analyze strengths and weaknesses in current quality circle components
to define P4Q threats and opportunities. The level of correspondence for both the
quality initiative independent approach and the quality initiative dependent approach
with the set of ‘to do’s’ is used as the central parameter. The feasibility of modifications
is assessed (see Appendix 12).
2.1.6 Consultation of Belgian stakeholders as involved country representatives
The assessment of the difficulties and possibilities to introduce Pay for quality in Belgium
was performed following different steps.
2.1.6.1 Selection of stakeholders
In a first step stakeholders were identified from national health care organizations,
institutions or organisational bodies that represented a potential interest in pay for
quality systems. The long list is presented in appendix 13.
For each stakeholder, we identified mother tongue, the institution where the person is
working and the stakeholder subpopulation the stakeholder belongs to. We aimed for
40 persons to be interviewed.
In a second step, the list of stakeholders was submitted to different scorers (all
academic experts), i.e. persons who know many people in the Belgian healthcare
system. They were asked to evaluate whether the different stakeholders on the long list
were persons who were sufficiently aware of and interested in the pay for quality topic.
For each name, 4 options were possible (corresponding with a point):
• Yes (1 point)
• No (minus 1 point)
• I do not know the person (no point)
• I do not know whether it is worthwhile to interview this person (no point).
All values were computed resulting into a classification of stakeholders. The scorers had
the opportunity to comment and add another name. The latter was considered
important in the case a stakeholder did not accept the interview or in case it was
necessary to complete the list of a particular subgroup.
The persons that acted as scorers to the long list were: