title: Leaders' experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review.
abstract: BACKGROUND
  Providing cost-effective, accessible, high quality patient care is a challenge to governments and health care delivery systems across the globe. In response to this challenge, two types of hospital funding models have been widely implemented: (1) activity-based funding (ABF) and (2) pay-for-performance (P4P). Although health care leaders play a critical role in the implementation of these funding models, to date their perspectives have not been systematically examined.
  
  
  OBJECTIVE
  The purpose of this systematic review was to gain a better understanding of the experiences of health care leaders implementing hospital funding reforms within Organisation for Economic Cooperation and Development countries.
  
  
  METHODS
  We searched literature from 1982 to 2013 using: Medline, EMBASE, CINAHL, Academic Search Complete, Academic Search Elite, and Business Source Complete. Two independent reviewers screened titles, abstracts and full texts using predefined criteria. We included 2 mixed methods and 12 qualitative studies. Thematic analysis was used in synthesizing results.
  
  
  RESULTS
  Five common themes and multiple subthemes emerged. Themes include: pre-requisites for success, perceived benefits, barriers/challenges, unintended consequences, and leader recommendations.
  
  
  CONCLUSIONS
  Irrespective of which type of hospital funding reform was implemented, health care leaders described a complex process requiring the following: organizational commitment; adequate infrastructure; human, financial and information technology resources; change champions and a personal commitment to quality care.
authors.affiliation: School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1. Electronic address: baxterp@mcmaster.ca.
authors.forename: Pamela E
authors.initials: PE
authors.lastname: Baxter
authors.affiliation: Faculty of Nursing, University of Alberta, 3rd floor, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, Canada T6G 1C9. Electronic address: skielly@ualberta.ca.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Hewko
authors.affiliation: Faculty of Nursing, University of Windsor, Rm. 324, Anthony P. Toldo Health Education Centre, 401 Sunset Avenue, Windsor, ON, Canada N9B 3P4. Electronic address: kpfaff@uwindsor.ca.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Pfaff
authors.affiliation: School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1. Electronic address: cleghol@mcmaster.ca.
authors.forename: Laura
authors.initials: L
authors.lastname: Cleghorn
authors.affiliation: School of Rehabilitation Science, McMaster University, 1280 Main St. W., Hamilton, ON, Canada L8S 4K1. Electronic address: bjcollins00@hotmail.com.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Cunningham
authors.affiliation: School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1. Electronic address: elstond@mcmaster.ca.
authors.forename: Dawn
authors.initials: D
authors.lastname: Elston
authors.affiliation: Faculty of Nursing, University of Alberta, 3rd floor, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, Canada T6G 1C9. Electronic address: gretac@ualberta.ca.
authors.forename: Greta G
authors.initials: GG
authors.lastname: Cummings
mesh_terms: D004469:Economics, Hospital / Q000458:organization & administration*; D006740:Hospital Administrators; D006801:Humans; D016730:Program Development; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D012052:Reimbursement, Incentive / Q000458:organization & administration*
keywords: Activity-based funding; Financial management; Funding; Funding model; Health care reform; Health facility administrators; Hospital; Pay-for-performance; Review; Systematic