Pamela E Baxter1, Sarah J Hewko2, Kathryn A Pfaff3, Laura Cleghorn4, Barbara J Cunningham5, Dawn Elston6, Greta G Cummings7. 1. School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1. Electronic address: baxterp@mcmaster.ca. 2. 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. 3. 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. 4. School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1. Electronic address: cleghol@mcmaster.ca. 5. School of Rehabilitation Science, McMaster University, 1280 Main St. W., Hamilton, ON, Canada L8S 4K1. Electronic address: bjcollins00@hotmail.com. 6. School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1. Electronic address: elstond@mcmaster.ca. 7. 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.
Abstract
INTRODUCTION: 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. PURPOSE: 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. Crown
INTRODUCTION: 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. PURPOSE: 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. Crown
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