Sustainable outcomes of an improvement programme: do financial incentives matter?

Andersson, Ann‐Christine; Idvall, Ewa; Perseius, Kent-Inge; Elg, Mattias

doi:10.1080/14783363.2013.791096

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…On the other hand, financial incentives may not be necessary for sustainable improvements in healthcare organisations, according to work by Anderson, Idvall, Perseius and Elg (2013). In their study of financial and non-financial incentives, the researchers investigated the question of, are financial incentive the determining elements for improvements in organisations?…”

Section: Introductionmentioning

confidence: 99%

The Role of Applying Total Quality Management in Improving Incentives: A Comparative Study between Jordanian and United Arab Emirate Hospitals

Khdour¹,

Durrah²,

A’aqoulah³

2016

IJBM

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<p>This study aims to identify the reality of a Total Quality Management (TQM) system and the level of its application on a sample of hospitals in Jordan and United Arab Emirates (UAE), together with determining the differences between both the Jordanian hospitals and UAE hospitals in their application of TQM. It also aims to identify the monetary and non-monetary incentives in hospitals, and to study the role of each dimension of various TQM dimensions on monetary and non-monetary incentives. A total of 160 questionnaires were distributed in six hospitals that were selected using a convenient sampling method. A total of 129 questionnaires were received, 74 of them were from Jordanian hospitals and 55 questionnaires were from UAEs hospitals. The participants were doctors, nurses, technicians, and administrators of six hospitals in Jordan and the UAE. An independent samples T-test and multiple regression analysis was used to test the hypotheses. The results showed that the application of TQM in both Jordanian and UAE hospitals was good, of a high level, and with a relative advantage for UAE hospitals. The results also showed that the incentives in Jordanian hospitals were generally better than those of the UAE hospitals, particularly in terms of the monetary incentives, while non-monetary incentives were the advantage for UAE hospitals. Moreover, it was found that only one dimension of the TQM dimensions, the participation of employees, had a significant effect on the monetary and non-monetary incentives in each of the Jordanian and the UAE hospitals (P value ≤ 0.05). While the rest of the dimensions of TQM (focus on the customer, continuous improvement, top management commitment, and teamwork) had no significant effect on both monetary and non-monetary incentives in both the Jordanian and the UAE hospitals.</p>

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Section: Introductionmentioning

confidence: 99%

The Role of Applying Total Quality Management in Improving Incentives: A Comparative Study between Jordanian and United Arab Emirate Hospitals

Khdour¹,

Durrah²,

A’aqoulah³

2016

IJBM

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“…The ESTHER transformation from a project to a mindset can be understood as a combination of methods, with attention to the psychology of change clearly embedded, including a unique combination of constantly stimulating and boosting intrinsic staff motivation (e.g., through the Esther story and by celebrating the name day). A more conventional way of stimulating motivation is the so-called “pay-for-performance”, where care units get extra pay for desirable work processes and outcomes [ 48 , 49 ]. This was never the case in ESTHER.…”

Section: Discussionmentioning

confidence: 99%

What is best for Esther? A simple question that moves mindsets and improves care

Vackerberg,

Andersson,

Peterson

et al. 2023

BMC Health Serv Res

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Background Persons in need of services from different care providers in the health and welfare system often struggle when navigating between them. Connecting and coordinating different health and welfare providers is a common challenge for all involved. This study presents a long-term regional empirical example from Sweden—ESTHER, which has lasted for more than two decades—to show how some of those challenges could be met. The purpose of the study was to increase the understanding of how several care providers together could succeed in improving care by transforming a concept into daily practice, thus contributing with practical implications for other health and welfare contexts. Methods The study is a retrospective longitudinal case study with a qualitative mixed-methods approach. Individual interviews and focus groups were performed with staff members and persons in need of care, and document analyses were conducted. The data covers experiences from 1995 to 2020, analyzed using an open inductive thematic analysis. Results This study shows how co-production and person-centeredness could improve care for persons with multiple care needs involving more than one care provider through a well-established Quality Improvement strategy. Perseverance from a project to a mindset was shaped by promoting systems thinking in daily work and embracing the psychology of change during multidisciplinary, boundary-spanning improvement dialogues. Important areas were Incentives, Work in practice, and Integration, expressed through trust in frontline staff, simple rules, and continuous support from senior managers. A continuous learning approach including the development of local improvement coaches and co-production of care consolidated the integration in daily work. Conclusions The development was facilitated by a simple question: “What is best for Esther?” This question unified people, flattened the hierarchy, and reminded all care providers why they needed to improve together. Continuously focusing on and co-producing with the person in need of care strengthened the concept. Important was engaging the people who know the most—frontline staff and persons in need of care—in combination with permissive leadership and embracing quality improvement dimensions. Those insights can be useful in other health and welfare settings wanting to improve care involving several care providers.

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“…In Sweden financial incentives have been used more recently in several national change initiatives directed at regions and provider organisations, but all aspects of these reforms have not yet been assessed. A recent study on financial incentives as driving force for improvements in healthcare indicated that finances do play a role, but aspects such as attention to improvements from management, dedicated staff, and practice-based projects can be equally or even more important for successful outcomes [ 41 ]. It is too early to evaluate the impact of the financial incentives in the Be-Life program, but the structured observations made of discussions among the regional actors during meetings indicate that the incentives influenced the motivation to act and participate in the program, at least on political and higher management levels.…”

Section: Discussionmentioning

confidence: 99%

Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people

Nyström

Strehlenert

Hansson

et al. 2014

BMC Health Serv Res

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BackgroundLarge-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies.MethodsA longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries.ResultsThis study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care.ConclusionsThere is no blue-print on how to approach the challenging task of leading large scale change programs in complex contexts, but our conclusion is that more attention has to be given to the multidimensional strategies that program management need to consider. This multidimensionality comprises different strategies depending on types of actors, system levels, contextual factors, program progress over time, program content, types of learning and change processes, and the conditions for sustainability.

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Sustainable outcomes of an improvement programme: do financial incentives matter?

Cited by 6 publications

References 24 publications

The Role of Applying Total Quality Management in Improving Incentives: A Comparative Study between Jordanian and United Arab Emirate Hospitals

The Role of Applying Total Quality Management in Improving Incentives: A Comparative Study between Jordanian and United Arab Emirate Hospitals

What is best for Esther? A simple question that moves mindsets and improves care

Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people

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