title: Implementing hospital pay-for-performance: Lessons learned from the French pilot program.
abstract: Despite a wide implementation of pay-for-performance (P4P) programs, evidence on their impact in hospitals is still limited. Our objective was to assess the implementation of the French P4P pilot program (IFAQ1) across 222 hospitals. The study consisted of a questionnaire among four leaders in each enrolled hospital, combined with a qualitative analysis based on 33 semi-structured interviews conducted with staff in four participating hospitals. For the questionnaire results, descriptive statistics were performed and responses were analyzed by job title. For the interviews, transcripts were analysed using coding techniques. Survey results showed that leaders were mostly positive about the program and reported a good level of awareness, in contrast to the frontline staff, who remained mostly unaware of the program's existence. The main barriers were attributed to lack of clarity in program rules, and to time constraints. Different strategies were then suggested by leaders. The qualitative results added further explanations for low program adoption among hospital staff, so far. Ultimately, although paying for quality is still an intuitive approach; gaps in program awareness within enrolled hospitals may pose an important challenge to P4P efficacy. Implementation evaluations are therefore necessary for policymakers to better understand P4P adoption processes among hospitals.
authors.affiliation: Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France. Electronic address: anne.girault@eleve.ehesp.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Girault
authors.affiliation: Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France. Electronic address: martine.bellanger@ehesp.fr.
authors.forename: Martine
authors.initials: M
authors.lastname: Bellanger
authors.affiliation: Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France. Electronic address: benoit.lalloue@gustaveroussy.fr.
authors.forename: Benoît
authors.initials: B
authors.lastname: Lalloué
authors.affiliation: Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France. Electronic address: loirat.philippe@wanadoo.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Loirat
authors.affiliation: Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France. Electronic address: jeanclaude.moisdon@free.fr.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Moisdon
authors.affiliation: Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France. Electronic address: Etienne.MINVIELLE@gustaveroussy.fr.
authors.forename: Etienne
authors.initials: E
authors.lastname: Minvielle
mesh_terms: D005602:France; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007857:Leadership; D010820:Physicians / Q000706:statistics & numerical data; D010865:Pilot Projects; D036301:Qualitative Research; D011787:Quality of Health Care; D012052:Reimbursement, Incentive / Q000592:standards*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Implementation; Incentive; Pay for performance; Qualitative evaluation