The impact of pay-for-performance on efficiency and effectiveness in clinical laboratory of Tabriz Imam Reza hospital

Abstract

Abstract Introduction: Nowadays target of all organizations are recruiting, keeping and flourishing skilled staff which designing a fair payment system is an important factor in achieving this target. Pay- for- performance (P4P) is a payment model which tries to pay to the measured aspects of performance and encourages health care providers by financial incentives in order to reach pre-defined goals. Objectives: This research was done to assess the impact of P4P on efficiency and effectiveness of medical laboratory of Imem Reza hoapital in Tabriz in 2013. Methodology: This research was a before and after study. Bonus payment of all laboratory staff was paied due to their performance from Mehr 1392 for 3 months. Efficiency and effectiveness indicators was found in a systematic review and finally 6 indicators was enterd in this study. In order to see any changes, efficiency of laboratory was measured and compared whole the year and effectiveness indicators were measured and compared in Khordad and Dey. Questionnaires were used to measure effectiveness, and related documents were used to measure efficiency. For comparing efficiency before and after descriptive statistics were used. For comparing staff satisfaction we used paired T and independent T test, and for comparing patient satisfaction we used chi-square based on correct P-Value and independent T test. Results: Comparing the data before and after intervention showes that P4P had a significant impact on staff satisfaction and patient satisfaction of staff behaviour aspect. Also findings of efficiency showed that costs didn’t differ significantly after the intervention, but revenue was a little increased (14364 to 16874). Laboratory errors were increased after the intervention too. Discussion: Regarding the positive impacts of P4P on effectiveness indicators in this study, and other similar studies, we can discuss that this bonus payment system can be used in all levels of care providing such as primary health care centers, drug stores, diagnostic centers and hospitals. Also better results can be achieved by setting pre-defined goals and considering negative point for any staff that do errors