The Hospital Value-Based Purchasing Program (HVBP), created by Section 3001 of the Patient Protection and Affordable Care Act passed in 2010, enacted a major industry shift in Medicare towards "pay for performance," or paying for high marks on a variety quality metrics rather than the traditional reliance on volume of care delivered. This study examines one of these quality metrics in particular: patient satisfaction. The trajectory of this paper begins with an overview of the current focus on patient satisfaction as a modern quality metric in American healthcare, contextualizes this emphasis on satisfaction within the intellectual movement of "patient-centered care," and moves on to a review of the relevant scholarship that attempts to explain the numerous determinants of patient satisfaction scores (with special attention to the inpatient hospital setting), as well as the robust academic debate over whether satisfaction is even an appropriate quality metric at all relative to clinical outcomes in care. The second half of my discourse moves on to more practical applications - first I break down the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and the impact of its methodology on providers, then the Medicare HVBP program itself and its various directions towards the value-based care model. I conclude with a quantitative analysis of trends in patient satisfaction over time between 1) HVBP-participating providers (as of FY2014) and 2) those providers who have not opted in (including those ineligible to do so). My comparison aims to study the strength of the HVBP incentives to improve patient satisfaction in those subject to the financial incentive relative to those who are not. Additionally, I preface this analysis whether patient satisfaction scores are associated with either clinical process of care scores or outcome scores in the HVBP program. My research questions aim to shed light on the academic debate between patient satisfaction and more traditional clinical outcomes - are they related in the context of FY2014 HVBP? Are the new incentives to improve patient satisfaction actually doing so in a meaningful way among providers newly accountable to these incentives? Finally, in a market defined by zero-sum resources, is there evidence that a financial incentives around patient satisfaction are channeling resources and by extension improvement away from clinical outcome performance? I believe this last question is the true concern of patient satisfaction skeptics, and hope to address it with applicable data. By providing a thorough qualitative grounding in the topic followed by current quantitative analysis, my goal is to create an informed perspective on the use of patient satisfaction as a quality metric in U.S. healthcare, which can be applied meaningfully from policy, provider, and consumer vantage points. With patient satisfaction becoming increasingly more internalized in the value-based care model, these analyses of the initial results in HVBP potentially serve as predictive insight into provider behavior in this area moving forward.

Objective: The primary objective of this study was to examine the relationship between hospital structural characteristics and penalization status (penalized or not penalized) in any given hospital acquired condition (HAC) Reduction Program year, FY 2015 through 2018. Structural characteristics included hospital type, case mix index, average daily census, bed size, ownership, disproportionate share percentage, location, and American Nurses Credentialing Center Magnet status. The secondary objective of the study was to determine whether a hospital's penalization status across one or more HAC Reduction Program years is related to quality performance (Total HAC Score) in subsequent years. These objectives were achieved through retrospective, longitudinal, multivariate regression analysis using 4 publicly available data sources. Background: The intention of pay-for-performance programs, including the Centers for Medicare and Medicaid HAC Reduction Program, is to improve the quality of care delivered; however, the theoretical and conceptual basis of pay-for-performance programs and their efficacy in improving care are widely debated. This study was designed to address the gap in knowledge related to the efficacy of value-based reimbursement as a means of motivating providers and organizations to improve healthcare quality. Results: Higher average daily census, disproportionate share percentage, and case mix index were associated with increased likelihood of receiving a penalty in the HAC Reduction Program. Approximately half (49%) of who did not experience a penalty at all improved their Total HAC Score. 51% of hospitals with 1 year of penalty improved their Total HAC Score; 54% of hospitals with 2 years of penalty improved their Total HAC Score; 73% of hospitals with 3 years of penalty improved their Total HAC Score. Conclusions: Despite the inability of some hospitals to meet the benchmark to avoid penalty, the vast majority of hospitals improved their performance over time. This finding holds promise for value-based reimbursement as a means for improving HAC incidence.

<p>Problem</p><p>Performance management på individnivå innebär att styra individen utifrån individuella mål som förmedlar organisationens övergripande strategi till medarbetarna. För att förstärka styreffekterna av individuella mål kan en belöning kopplas till måluppfyllelsegrad. Effekten av ett bonussystem ställer stora krav på samarbete mellan chef och anställd då de tillsammans ska ställa upp realistiska mål som syftar till att utveckla den enskilde individen samtidigt som de bidrar till organisationens övergripande mål och resultat. Därmed är det viktigt att undersöka hur medarbetare och chefer påverkas av individuella mål kopplade till bonus och vilka effekter detta får inom företaget. Vilken effekt har målsättnings-, uppföljnings- och utvärderingsarbetet på styrning och motivation bland medarbetare och chefer?</p><p>Syfte</p><p>Syftet är att undersöka och öka förståelsen kring hur styrning och motivations-aspekter påverkas då performance management bryts ner till individnivå samt hur en belöningskoppling kan förstärka den eventuella styreffekten.</p><p>Metod</p><p>Undersökningen har genomförts i form av en fallstudie där intervjuer använts som främsta empiriinsamlingsmetod. Intervjuverktyget valdes för att få en förståelse för hur performance management påverkar personer inom en organisation utifrån ett styr- och motivations-perspektiv. Det gav möjlighet till att undersöka problemet på en djupare nivå där olika synsätt och åsikter kring ämnet kunde fångas upp under personliga intervjuer.</p><p>Resultat</p><p>Undersökningen visar att styrfilosofin inom en organisation inte påverkas i nämnvärd utsträckning av performance management på individnivå. Det som påverkas är hur organisationen väljer att hantera styrningen i form av de svårigheter som uppstår i och med att målen blir individuella. De största svårigheterna med ett individuellt målsättningsprogram är att få en jämvikt mellan finansiella och ickefinansiella mätetal där målen kommuniceras och förankras hos medarbetarna på ett fungerande sätt. Trots att de mjuka målen uppfattas som oerhört viktiga på individnivå så är det dessa mål som skapar de största svårigheterna. Fallstudien har visat att en tydlig målsättning med konkreta och realistiska mål är en förutsättning för att påverka styrningen i positiv riktning. Det framgår även att rättvisa är viktigt i och med att en bonus kopplas till måluppfyllelsegrad varför kvalitén på målsättningsarbete och uppföljningen är av stor vikt.</p> / <p>Problem</p><p>Performance management helps the organisation clarify the strategy through individual targets. To reinforce the management effect a bonus can be connected to the fulfilment of targets. When a bonus is connected to performance management it is vital that the communication between managers and co-workers is well functioning and that the individual targets support the co-workers learning as well as they support the organizations overall targets. Therefore it is important to investigate how co-workers and managers are affected by individual targets and what consequences it has on the organization. What impact has the target setting-, follow up- and evaluation process on the organisation’s management and the motivation among the staff?</p><p>Purpose</p><p>The purpose of this study is to investigate and increase the understanding of how management and motivational aspects is affected when performance management is broken down to individual levels and how a reward can enhance the possible control effect.</p><p>Method</p><p>This study has been performed through a case study where interviews have been the primary method. Several interviews were conducted to gain an understanding of how performance management influences employees in an organization on the basis of a control and motivational aspect. Interviews made it possible to examine the purpose on a deeper level, where different opinions and approaches to performance management could be collected.</p><p>Result</p><p>The control function is not influenced by the fact that performance management is broken down to individual levels. The difficulty with this topic is the problems that arise when targets are made individualized. Individual targets make it hard to find a balance between financial and non-financial measurements and to gain the approval of employees. Non-financial goals cause the biggest problems since these are the hardest goals to measure and reward. Despite problems surrounding the non-financial goals there exist a great confidence in such goals. The case study shows that performance management on an individual level demands a well functioning communication to effect organisational management in a positive direction. It also shows that a bonus connected to targets demands a high quality in the rewarding procedure where justice plays an important part.</p>

No description available.

No description available.

Problem Performance management på individnivå innebär att styra individen utifrån individuella mål som förmedlar organisationens övergripande strategi till medarbetarna. För att förstärka styreffekterna av individuella mål kan en belöning kopplas till måluppfyllelsegrad. Effekten av ett bonussystem ställer stora krav på samarbete mellan chef och anställd då de tillsammans ska ställa upp realistiska mål som syftar till att utveckla den enskilde individen samtidigt som de bidrar till organisationens övergripande mål och resultat. Därmed är det viktigt att undersöka hur medarbetare och chefer påverkas av individuella mål kopplade till bonus och vilka effekter detta får inom företaget. Vilken effekt har målsättnings-, uppföljnings- och utvärderingsarbetet på styrning och motivation bland medarbetare och chefer? Syfte Syftet är att undersöka och öka förståelsen kring hur styrning och motivations-aspekter påverkas då performance management bryts ner till individnivå samt hur en belöningskoppling kan förstärka den eventuella styreffekten. Metod Undersökningen har genomförts i form av en fallstudie där intervjuer använts som främsta empiriinsamlingsmetod. Intervjuverktyget valdes för att få en förståelse för hur performance management påverkar personer inom en organisation utifrån ett styr- och motivations-perspektiv. Det gav möjlighet till att undersöka problemet på en djupare nivå där olika synsätt och åsikter kring ämnet kunde fångas upp under personliga intervjuer. Resultat Undersökningen visar att styrfilosofin inom en organisation inte påverkas i nämnvärd utsträckning av performance management på individnivå. Det som påverkas är hur organisationen väljer att hantera styrningen i form av de svårigheter som uppstår i och med att målen blir individuella. De största svårigheterna med ett individuellt målsättningsprogram är att få en jämvikt mellan finansiella och ickefinansiella mätetal där målen kommuniceras och förankras hos medarbetarna på ett fungerande sätt. Trots att de mjuka målen uppfattas som oerhört viktiga på individnivå så är det dessa mål som skapar de största svårigheterna. Fallstudien har visat att en tydlig målsättning med konkreta och realistiska mål är en förutsättning för att påverka styrningen i positiv riktning. Det framgår även att rättvisa är viktigt i och med att en bonus kopplas till måluppfyllelsegrad varför kvalitén på målsättningsarbete och uppföljningen är av stor vikt. / Problem Performance management helps the organisation clarify the strategy through individual targets. To reinforce the management effect a bonus can be connected to the fulfilment of targets. When a bonus is connected to performance management it is vital that the communication between managers and co-workers is well functioning and that the individual targets support the co-workers learning as well as they support the organizations overall targets. Therefore it is important to investigate how co-workers and managers are affected by individual targets and what consequences it has on the organization. What impact has the target setting-, follow up- and evaluation process on the organisation’s management and the motivation among the staff? Purpose The purpose of this study is to investigate and increase the understanding of how management and motivational aspects is affected when performance management is broken down to individual levels and how a reward can enhance the possible control effect. Method This study has been performed through a case study where interviews have been the primary method. Several interviews were conducted to gain an understanding of how performance management influences employees in an organization on the basis of a control and motivational aspect. Interviews made it possible to examine the purpose on a deeper level, where different opinions and approaches to performance management could be collected. Result The control function is not influenced by the fact that performance management is broken down to individual levels. The difficulty with this topic is the problems that arise when targets are made individualized. Individual targets make it hard to find a balance between financial and non-financial measurements and to gain the approval of employees. Non-financial goals cause the biggest problems since these are the hardest goals to measure and reward. Despite problems surrounding the non-financial goals there exist a great confidence in such goals. The case study shows that performance management on an individual level demands a well functioning communication to effect organisational management in a positive direction. It also shows that a bonus connected to targets demands a high quality in the rewarding procedure where justice plays an important part.

Can pay-for-performance increase the motivation of public employees? By providing a basis for personnel decisions, particularly linking rewards to performance, performance appraisals aim to increase employees' work motivation and ultimately to improve their work performance and organizational productivity. With the emphasis on results-oriented management, performance appraisals have become a key managerial tool in the public sector. Critics charge, however, that pay-for-performance is ineffective in the public sector, largely because the link between performance and rewards is weak. However, no one has empirically measured the strength of the linkage. If performance ratings do have an impact on career success in the federal service, they might contribute to race and gender inequality. Although many studies have examined factors affecting gender and racial differences in career success, studies that try to connect gender and racial inequalities to managerial tools are scarce. Using a one percent sample of federal personnel records, the first essay examines the impact of performance ratings on salary increases and promotion probabilities, and the second essay explores whether women and minorities receive lower ratings than comparable white males, and women and minorities receive lower returns on the same level of performance ratings than comparable white males. The first essay finds that performance ratings have only limited impact on salary increases, but that they significantly affect promotion probability. Thus, the argument that performance-rewards link is weak could be partially correct, if it considers only pay-performance relationships. The second essay finds that women receive equal or higher performance ratings than comparable white men, but some minority male groups, particularly black men, tend to receive lower ratings than comparable white men. On the other hand, the returns on outstanding ratings do not differ between women and minority male groups and white men, though women groups seem to have disadvantages in promotion with the same higher ratings as comparable men in highly male-dominant occupations.

From establishing government in 1949, Communist Party of China had pursuing a socialist system. However, over-emphasis on equal distribution lead to the individual income and the individual performance are not proportional, so that the mainland China was under the circumstances of "usually used in negative two half kilogram," and was near to the border of collapse. After Deng Xiaoping came back to power, threw away the past ideology of equal distribution, and he changed the economic system. China's economy began to advance by leaps and bounds. Nowadays, the mainland China¡¦s eco-nomic potentiality has surpassed Japan and it becomes the second economy which is only inferior to the U.S. economy. However, in so dazzling economic performance of mainland China's, the achievement of economic growth is not generally reflected in the labor standards on wages, The wages of workers in China still ranked among the last level of the world's wage classes. However, the average wage in the low social workers, the Gini coefficient is close to the bottom line of social tolerance. That is, how to set up wage growth mechanism, straighten out the relationship between income distribution has became a top priority of mainland authorities. This pay for performance system for the mainland legal system are based on the mainland of the State Council "pay for per-formance on the compulsory school system guidance," analysis to explore the subject, to be addressed. This paper is divided into seven chapters around: Chapter 1 Introduction, describes the study of this motivation, purpose, scope, methods, limits, and proposed research framework. Chapter 2 is to explore the mainland of the basic principles of pay for per-formance system, Chapter 3 of the mainland of the administrative organization of pay for performance system. Chapter 4 is to explore the mainland China of pay for perfor-mance system administrative privileges. Chapter 5and Chapter 6,are respectively to ex-plore the mainland China of performance pay system and monitoring of relief, and in Chapter 7 are conclusions and recommendations of pay for performance system

In 2003, the Florida legislature appropriated funds to finance pilot programs (1012.231, Florida Statutes) to prepare for the 2004-2005 school year in which pay for performance initiatives were to be implemented in each district. Therefore, the purpose of this study was to examine and describe the planning, processes, and implications of a pilot career ladder program that was implemented into a large Florida school district in the spring of 2004. During data collection, the program was terminated therefore creating a second purpose that sought to describe residual implications of a program when it is discontinued. Data collected for this study were used to respond to six specific research questions. The first inquired about the planning process prior to implementation. Archival documents were used to determine whether research-based strategies were involved. The second through the fifth questions rely heavily on survey and structured interview data collected by the district and the primary researcher respectively and seek to determine critical perspectives from teachers and administrators regarding the career ladder including knowledge, fairness, and implications for school and district. The sixth question asks whether residual effects remain in place after an initiative has been terminated. Particularly, as a major finding, time for implementation was a theme throughout the study as most respondents were concerned about the short timeline this program had to develop fully. Stakeholder buy-in and understanding of program roles emerged from the data. However, the notion of a mentor that was given the time and resources was frequently mentioned as a benefit to new teachers and the school overall. Furthermore, respondents saw the potential long-term benefit of staff development that would allow highly trained master teachers to coach new and struggling teachers during the day in a clinical setting. There was evidence that this program did have an initial negative impact on the culture of the schools in the district. One unplanned aspect of this case study was the fact that the program was terminated at the state level. This had implications for all stakeholders and could be a strong factor in later implementations; therefore, this would require further study.

Quality-based payment in healthcare&mdash;also known as pay-for-performance&mdash;is a popular policy intervention aimed at improving healthcare quality. However, there has been little theoretical work characterizing the underlying quality problem or the interaction between pay-for-performance and existing payment mechanisms. Furthermore, there is little empirical evidence that pay-for-performance has a substantial effect on healthcare quality.