Pay for Quality

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14 Pay for Quality KCE Reports 118 For French-speaking stakeholders: • Geneviève Bruwier (ULg) • Michel Roland (ULB) • Pierre Gillet (ULg) • Marc Vanmeerbeek (ULg) For the Dutch-speaking stakeholders • Jan Heyrman (KUL) • Lieven Annemans (VUB, UGent) • Walter Sermeus (KUL) • Roy Remmen (UAntwerpen) Based on the aggregated scores given by the scorers a ranking was made for every respective category of stakeholders. A total and maximum number of about 40 stakeholders were finally selected, representing a balance between Dutch and French speaking persons. The selection was made in close cooperation with the KCE. 2.1.6.2 Design of the questionnaire A questionnaire was developed in parallel with the selection of the stakeholders. This questionnaire: • Was based on state of the art literature with regard to pay for quality. • Included open-ended questions • Was reviewed by experts from the USA, the UK, The Netherlands and France. The questionnaire (appendix 14) was developed following the usual approach of qualitative methodology. It started with an explanation for agreement on basic terminology about pay for quality concepts. It comprised introductory questions to facilitate the communication and allow the free expression of personal opinions; more narrow questions to cover the whole topic; closing questions so that the interviewee can develop some previous answers or some new ideas about the topic. Questions were open-ended to allow the stakeholder’s free expression. A list of detailed questions was provided one week on beforehand. We proposed each interviewee to imagine a P4Q programme being developed in Belgium. Without further details, we asked him/her to state his/her opinion on advantages, disadvantages, pitfalls and expected resistances to such a programme. Then, we discussed the above more in detail following all elements of the theoretical framework (see Chapter 3). Final questions were related to the budget and open to more economic view of the impact of such a programme. The last question asked about the stakeholder’s knowledge of other experts in the field or persons having developed such a programme. This allowed the team to be sure to cover the whole expertise in the domain in Belgium and eventually abroad. It goes without saying that the interviewee was allowed to complete or put the emphasis on one point of interest by the usual prompt: “Do you want to add something, do you think we have forgotten one important point?”
KCE Reports 118 Pay for Quality 15 2.1.6.3 Protocol of the interviews As a protocol to this questionnaire the stakeholders first received a letter from the KCE to present the study and to ask if they knew some P4Q studies already developed in Belgium. Then, they were contacted by phone to arrange an appointment. The interviews were conducted by two academic teams, including three Flemishspeaking researchers (KUL: JH, LB and CVdB) and two French-speaking researchers (ULg: MV and CD). The Flemish-speaking interviewers were assisted by a student who took notes of what was said whilst the interview was tape-recorded. The French-speaking interviewers were usually alone but recorded the whole interview. Interviews lasted for 50 minutes to more than 2 hours. 2.1.6.4 Analysis of the content of the interviews To guarantee as much as possible the objectivity and the reproducibility of the conclusions within the chosen qualitative approach, the following steps where used to come from interview to integrated conclusions: • Basically the interview structure followed the conceptual framework, so that the answers could maximally fit into and contribute to the framework reflection. • All interviews were audio taped or written down. • Answers were translated from French or Dutch into English and transformed to more condensed “long list of quotes” by each of both interviewers, and put to mutual agreement. All quotes where marked with the name of the interviewee and his/her adherence to the stakeholders’ typology (government, academics, unions, primary care, hospitals, etc…) and language group. The total list of quotes was made available to each of the two academic team members. • As a first analysis, the quotes were assigned as close as possible to the theoretical framework and its different subheadings. • The exercises of omitting unproductive quotes, eliminating overlap and repetition, and condensing different quotes to one statement was done by half of the academic team, under control of the other half. The decisions about the final “reduced list of quotes” were taken during a common open meeting of the whole team. • A final reduced list of “interesting quotes, including their origin” was constructed and is still available at the courtesy of the research team. An agreement was made with the stakeholders not to publish names and affiliation. From this “reduced list of quotes” half of the academic team made a readable and prioritized text version of the final conclusions emerging from these quotes, the other half controlled this exercise. Statements of stakeholders were, if appropriate, put in contrast or in support with the messages from the international literature study and the conceptual framework. Only these condensed messages are reported, referring to categories as “some / many / most of / all stakeholders”, “primary care versus hospital care stakeholders”, “union versus government stakeholders” and “French region versus Flemish region stakeholders”. • Two meetings were necessary to extract main messages and to bring them together with the general conclusions of the whole project in chapter 9.
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