title: Quality-based procedures in Ontario: exploring health-care leaders' responses.
abstract: OBJECTIVE
  To examine health-care leaders' initial response to the implementation of orthopaedic quality based procedures (QBPs) in hospitals across Ontario, Canada.
  
  
  BACKGROUND
  In 2012, Ontario, Canada shifted 91 hospitals to a patient-based funding (PBF) approach. This approach funds health-care organisations based on the number of patients treated with select procedures known as QBPs.
  
  
  METHODS
  An exploratory descriptive design was employed to better understand health-care leaders' early implementation experiences. Seventy organisational leaders from 20 hospitals participated in six focus groups and four interviews to discuss their initial responses to the implementation of two QBPs (primary unilateral hip replacement and primary unilateral knee replacement). Qualitative data underwent content analysis.
  
  
  RESULTS
  Three key major themes emerged; (1) responding to change, (2) leading the change and (3) managing the change. Within each of these themes, barriers and benefits were identified.
  
  
  CONCLUSIONS
  Leaders are accepting of PBF and QBPs. However, challenges exist that require further exploration including the need for a strong infrastructure, accurate and timely clinical and financial data, and policies to prevent unintended consequences.
  
  
  CONCLUSIONS
  Implementing QBPs requires careful planning, adequate and appropriate resources, vertical and horizontal communication strategies, and policies to ensure that unintended consequences are avoided and positive outcomes achieved.
authors.affiliation: McMaster University, School of Nursing, Hamilton, Ontario, Canada.
authors.forename: Pamela
authors.initials: P
authors.lastname: Baxter
authors.affiliation: McMaster University, School of Nursing, Hamilton, Ontario, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Cleghorn
authors.affiliation: Hamilton Health Sciences Centre Surgical Oncology, Orthopaedics and Critical Care, Hamilton, Ontario, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Alvarado
authors.affiliation: University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada.
authors.forename: Greta
authors.initials: G
authors.lastname: Cummings
authors.affiliation: Sunnybrook Health Sciences Centre, Holland Orthopaedic & Arthritic Centre, Toronto, Ontario, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kennedy
authors.affiliation: McMaster University, School of Nursing, Hamilton, Ontario, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: McKey
authors.affiliation: University of Windsor, Faculty of Nursing, Windsor, Ontario, Canada.
authors.forename: Kathy
authors.initials: K
authors.lastname: Pfaff
mesh_terms: D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards*; D017144:Focus Groups; D006801:Humans; D007857:Leadership; D009864:Ontario; D017064:Process Assessment, Health Care / Q000379:methods / Q000592:standards; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods*
keywords: health-care; leadership; patient-based funding; quality-based procedures