The Institute for medicine has recommended pay for performance for the physicians to improve the quality of healthcare. Such a move is derived from the notion that financial remuneration for the healthcare providers should be proportionate to the care they provide to the patients. According to this concept, improvements in the performance of the provider lead to an overall improvement in the quality of medical care. Such an assumption remains unproven. If such an approach is correct, it can be assumed that assessing the provider performance should follow quality improvement principles that are currently in use in a healthcare setting. Such principles apply to systems and Microsystems in a wider network and may be adapted to evaluate the performance of an individual provider or even groups in a discipline. Pay for performance initiatives measures the contribution of the care provider under assessment independent of the contribution of other components that includes other providers. It assigns a monetary value to the improvement measured that necessitates value judgment that is arbitrary when two groups of providers are compared in different settings. An important step to assess provider performance is choosing between one or more measures of performance which are known as the metrics. Poor selection of the indicators contributes to limited efforts. Data for the entire process must also be extracted in a timely manner (Britton, 2014; Campbell, Reeves, Kontopantelis, Sibbald & Roland, 2009; Silverman, 2011). This research paper identifies the sections that will be included in the research process for a qualitative research on the topic.
Available Literature
According to de Bruin, Baan & Struijs, (2011) pay for performance is a model that rewards healthcare providers for meeting set targets for the delivery of healthcare through financial incentives. The providers receive additional or reduced payments based on their performance. According to the author, most of the incentives used include rewards that are granted on the basis of performance. Some of the features identified by the authors include the type, nature, focal quality, the scope, the motivation, the scale, size, certainty and frequency, and duration. These features have different dimensions that are applicable to each. According to the author, different studies showed positive effects of pay for performance on the quality of care delivered. In one of the studies, financial incentives promote better clinical management of patients with diabetes.
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The health care system irrespective of whether it is private or public is exposed to unique problems that have been ignored for long. According to Maynard (2005), the following five problems affect healthcare delivery. The problems include incomplete evidence of what is effective in medicine. There are also variations in clinical practices. It is difficult to determine the appropriateness of service delivery. There are also issues of patient safety and lastly, policy makers and providers are reluctant to use patient-reported outcome measures.
The use of information technology in the US represents a paradox in that much of the hardware for the healthcare infrastructure is developed in the US yet the system relies on a complex framework that is compounded by the pluralism of the country that has made it difficult to establish national standards (Maynard, 2005). Technology can be used to simplify some of the challenges experienced by the healthcare system by incorporating its capabilities to the entire process contributing to improved performance derived from speedy processing and sharing of information.
Drawbacks of Pay for Performance
The effect of the P4P initiatives on patient outcome is still contested with some studies showing varied outcomes. The significant costs associated with the program worsens the situation with some studies indicating that such measures are counterproductive to their objective of improving patient outcome by improving the quality, and efficiency of healthcare. The implementation of P4P programs, therefore, needs long-term monitoring and evaluation. There is also need to conduct further research on the issue to determine whether financial incentives are cost-effective interventions that improve the quality of healthcare (Mandavia, Mehta, Schilder & Mossialos, 2017). According to studies on hospital and physician performance in pay for performance, the size of the organization, the teaching status, practice type, and the age of the physician and their gender affected performance in P4P. For physician and hospital, a substantial proportion of minority and low-income patients received poor performance. The influence of information technology and staffing levels contributed to mixed results. Similarly, there are contradicting results on the effects of the likelihood of the bonus, its size and marginal cost on performance indicators that there are varied responses to financial incentives by different providers (Markovitz & Ryan, 2016).
This study uses qualitative research to study the impact of merging technology and pay for performance on the outcome of a patient. Non-numerical data, therefore, will be used as the researcher seeks to interpret the meaning from collected data to understand the topic under investigation. Qualitative research focuses on the micro level of pay for performance and the adoption of technology and how the two can influence patient outcome. Some of the methods involved in this study include interviews and open-ended surveys (Britton, 2014).
This study allows the researcher to investigate the outcome of the interaction of technology and pay for performance on the services delivered to the patient. It will help the researcher to establish whether there is a relationship between the two variables. The study will investigate meaning, interpretation, processes and the relations that exist between the variables which can be obtained from descriptive data that must be interpreted using different techniques. The inductive method is used in this case which can then be tested by conducting further research (Britton, 2014)
For the purposes of this study, the researcher will use qualitative interview which is a type of a framework where the practices and standards are recorded and achieved, challenged and reinforced by the researcher. This research employs semi-structured data collection processes throughout the study where the respondents will be allowed time to express their opinions with minimal interference of the entire process. The respondent will be required to answer open-ended questions that had already been preset. The questions will be sent to the respondent via email using the student’s email address (Silverman, 2011).
Semi-structured interviews will involve in-depth interviews that require the respondent to answer existing open-ended questions. It is a process that is used extensively to interview individual or even groups. It will be conducted only once with an individual or even groups where applicable. The entire process is expected to last for thirty minutes for each participant. The semi-structured interview guide will be used by the researcher. The guide is a schematic presentation of the questions that will be dealt with by the interviewer. Interview guides explore the many respondents systematically and in a comprehensive manner to achieve the optimum use of interview time. They also ensure that the interview focuses on the desired path. The interview guide will include the core questions and the associated questions that relate to the central question (Silverman, 2011)
Improvements were made to the questions in a pilot study that was intended to determine the ability of the instruments to meet their desired goal. Some items were deleted while others were modified to ensure that the guide collected adequate data that could be analyzed quantitatively to obtain an inference. Capturing of the data will be done by the respondent at their free time where they are required to fill the schedule and return it on time (Silverman, 2011).
The objectives of sending the interview schedule early are to allow the respondent ample time to complete it on time and send the schedule to the researcher for analysis. Similarly, it presents an opportunity to the researcher to follow up and remind the participants to complete the questionnaire on time. Another objective is that it enables proper planning in that the researcher can send more interview questions to other respondents if they determine that the response rate is low to provide an adequate sample that can be analyzed to draw an inference or to obtain data that is representative of the entire population (Silverman, 2011).
Challenges of merging technology with Pay for performance programs
In a pay for performance program, healthcare providers receive financial incentives once they achieve set targets on performance measures that are already predefined. The premise is that health care providers are responsive to financial incentives awarded to them for reaching a target. The goal of the program is to improve the outcome of the patient while eliminating unintended consequences. It could also mitigate against cost if it can contribute to the better prevention and disease management and by incorporating efficiency measures (Doran, Kontopantelis, Reeves, Sutton & Ryan, 2014).
The use of information technology poses a whole range of challenges to the implementers of the program given that performance will be based on metrics that can be understood by the information technology. Majority of the metrics will be based on numerical figures determined by programmed values that process the raw data that is fed to the system. It is challenging to establish the information technology to be used, establishing indicators and the design of a balanced scorecard and the availability of excess information that needs to be sifted through to obtain reliable and accurate information (Britton, 2014; Vilaseca et al., 2009).
The use of technology in a pay for performance program may not attract full support from the entire organization. Majority of the service providers prefer to retain the existing programs for fear of poor performance or not knowing the consequences of such changes. Providers have a role to play in the success of the program. It is their responsibility to provide timely information and ensure that the information is fed accurately to the system and reflects their efforts. The use of the wrong inputs leads to inaccurate information that can contribute to a higher or lower pay. It is from this perspective that the providers must cooperate with the administrators to ensure the accuracy of their data to avoid future disappointments (Chingos, 2007).
Information technology despite having many advantages can lead to problems if the system is attacked intentionally or unintentionally both from within and outside. Some employees would like to manipulate the system to show impressive performance hence leading to higher pay. It is at this point that such systems should be secured from unauthorized entry and manipulation of information. The process of merging pay for performance with technology should also consider the different types of application, their ease of use, the type of output desired from the system, the configuration of the system and the security of the system and network (Hennink, Hutter & Bailey, 2015).
It is necessary therefore to ensure that proper training is conducted for all providers to ensure that all the different aspects are clearly understood by the primary stakeholders and they know their roles and responsibility. The information system should be simple to operate and manage. It should also be compatible with the other system in the network. Care should be taken to ensure that the information technology does not take precedence over other initiatives like managing the organization, motivating and staffing (Hennink, Hutter & Bailey, 2015).
Sufficiency of the qualitative interview will be determined by its ability to collect data that can be used to draw a conclusion. The data so collected must be able to achieve the desired objective for the study. It should not leave grey areas in the question under study but should exhaustively deal with the issue. The researcher will determine when to stop collecting additional data if it emerges that no new data is acquired from subsequent interviews. If all the data from new qualitative interviews is the same like the previously obtained data, the researcher should stop any further data collection and start analyzing the already collected data (Hennink, Hutter & Bailey, 2015).
The data obtained from the qualitative interview will then be transcribed to understand what data is available and not the expected data. It will involve closer scrutiny of any recorded data. It helps the researcher to familiarize themselves with the data and establish an overview of the entire data. Once transcription is over, the researcher then grouped according to similar characteristics that make it possible to analyze the grouped data. Grouping the data allows the performance of simple statistical techniques like average, median and the mean. Grouping also helps in condensing the data to manageable volumes that can easily be handled during data analysis (Hennink, Hutter & Bailey, 2015; Silverman, 2011).
Several analyses techniques can be used in qualitative research. Some of the approaches include phenomenology, hermeneutics, grounded theory, phenomenographic, ethnography and content analysis. The qualitative analysis will involve simple to complex techniques that will help obtain the desired information for drawing a conclusion. The researcher can use a combination of techniques to analyze the data. One of the simple approaches will be to use content analysis because it is not related to any science and it has fewer rules to follow. It, therefore, reduces any confusion that arises from the uses of the different techniques. The researcher, in this case, will maintain a qualitative perspective and strive to achieve credibility and rigor to ensure that the results are trustworthy (Bengtsson, 2016). Flexible data analysis plan will be used by the researcher. The starting point can be Thematic Analysis, especially when dealing with flexible and non-research design specific data analysis plan. The data will be coded to enable further processing using quantitative techniques (Clarke & Braun, 2017). The research data will then be coded to make it easier to process. A combination of content analysis, descriptive qualitative and Ethnography coding strategies will be used for this study. The researcher will use Excel to conduct a simple analysis of the data like finding the averages and the mean. SPSS will be used to conduct other types of analysis including correlation, regression, ANOVA among others (Hennink, Hutter & Bailey, 2015).
Potential ethical procedures arise during data collection. The researcher must obtain informed consent from the participants. Similarly, the confidentially of the information will be guaranteed and the participants will be informed that the obtained data will only be used for purposes of research only. Anonymity will also be another factor that the researcher must consider throughout the process from data collection to data analysis. It is the responsibility of the participant to agree to participate in a study or not. They can also discontinue at any strep if they are not willing to continue with the research (Hennink, Hutter & Bailey, 2015; Silverman, 2011).
Qualitative research methods require that the researcher follows an established process to complete the study. In this research, the researcher will be interested in identifying how merging technology with pay for performance affects the patient outcome. The researcher will collect qualitative data using qualitative interviews. The data collection process will involve semi-structured qualitative interviews. The researcher will distribute the consent forms to the participants for them to sign and interview questions will be mailed to them. Data collection will be conducted earlier enough to ensure that the adequate data is obtained on time. The researcher will identify the challenges of merging technology with pay for performance programs and also identify measures to ensure that the interviews are sufficient. The study will employ different techniques for data analysis, and analysis plan. Similarly, a combination of coding strategies will be used by the researcher. Lastly, the research identifies potential ethical issues affecting the research (Hennink, Hutter & Bailey, 2015; Silverman, 2011).
Reporting
The researcher will write a report of the research findings which will contain objective information and facts obtained from the qualitative research. The original data and the analysis will be presented in the report. The researcher will use text and visual aids and then interpret the results. The section will include headings and subheadings like results and discussion. It will also use the appropriate language and refer to figures correctly (Hennink, Hutter & Bailey, 2015; Silverman, 2011).
Results
The results section will be used to accept or reject the hypothesis of the study. it will help the researcher to understand the problem from within and break it into pieces and address the research problem from different perspectives. The section will use nontextual elements to present the results in an effective way. The section will present qualitative and quantitative data. The section will only present data that is critical to the research question. The section will first present the results and then explain it then present the next result and explain until all the results are presented and explained. The results will be organized under key themes that are related to address the research problem (Hennink, Hutter & Bailey, 2015; Silverman, 2011).
Discussion
The discussion of the qualitative research will incorporate a detailed explanation of the results. The researcher will comment whether the results were expected while giving a detailed explanation of the findings that were profound or unexpected. Any unusual or unanticipated patterns will also be noted. Similarly, the study will identify any trends observed in the results. The section will also compare the findings to available and in some instances use such findings to support a claim. The researcher will revisit already cited sources in the literature review. Similarly, new literature will be used in this section especially if it is established that it is more appropriate for the discussion section rather than the general literature review section. The section will further make a deduction which is a claim of how results can be applied. It is at this juncture that the researcher will identify lesson learned, propose any recommendations or highlight the best practices. The section will also indicate whether the hypothesis was true or false and can be framed as a new research question that arises from the analysis (Hennink, Hutter & Bailey, 2015; Silverman, 2011).
The discussion will try to reiterate the research problem by stating the key findings. It will explain the findings and their importance and relate them to similar studies that were conducted by other researchers. The sections will also consider other explanations to the findings apart from those that fit the hypothesis of the study. The study limitations will also be acknowledged in this section and suggestions for further studies made (Hennink, Hutter & Bailey, 2015; Silverman, 2011).
Conclusion
The conclusion will discuss the meaning of the research findings more than their statistical meaning. The researcher will interpret the findings and show what can be concluded from them. it will also indicate whether the results are similar to the initial expectations or what the researcher predicted. The researcher will again state whether the hypothesis was supported and why and identify the limitations and the relationship of the results with the problem under study. The research will state whether any alternatives can make a difference or solve the problem or even improve the current situation. The short term and long term goals of the study can also be stated here. Lastly, the researcher will state the relationship of the research findings to existing literature (Hennink, Hutter & Bailey, 2015; Silverman, 2011).
References
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