Pay-for-Performance Payment and Effects: Nursing Perspective

Öz

Aim: Pay-for-performance payment initiatives attempt to improve the quality of care by aligning desired care processes and outcomes with reimbursement. The main focus of Pay-for-performance payment has been on physicians, with relatively less attention given to its potential impact on nurses. In addition, the impact of pay-for-performance payment criteria on nursing care and processes has not been widely studied. However, in acute care settings, such as during the COVID-19 Pandemic, interest in pay-for-performance payment criteria in nursing has increased due to its impact on care processes and patient outcomes. As pay-for-performance payment standards develop and encompass patient outcomes, the contributions of nurses will attract attention. This study was conducted to examine pay-for-performance payment models specific to nurses and their effects on nurses and healthcare systems. Method: For this purpose, the effects of pay-for-performance payment methods on healthcare services were discussed and studies conducted on this subject were reviewed. In addition, pay-for-performance payment models implemented in both developed and developing countries were examined. Finally, the study examined pay-for-performance payment models specific to nurses and included studies on the effects of pay-for-performance payment on nurses. Results: The general assumption regarding the effects of pay-for-performance payment on healthcare services is that it will motivate healthcare workers and managers to increase productivity and quality of care and ultimately strengthen the healthcare system. An appropriate incentive package is essential for the success of a pay-for-performance payment program. However, it is argued that sustainable and supportive management and audit systems, appropriate equipment, essential medicines and other medical supplies are essential for the success of the program. It is important that the pay-for-performance payment to be developed specifically for nurses creates a supportive environment where nurses are motivated to excel through positive reinforcement and rewards rather than fearing the results. Nurses have many duties both individually and within the team, and performance evaluation criteria can be made in accordance with these duties. Conclusion: As a result of the study, suggestions were made on issues that need to be considered in the development of a successful performance-based payment model specific to nurses. Originality: This study provides a comprehensive review of performance-based payment models specific to nurses and the effects of performance-based payment methods on nurses and health systems, thus making a significant contribution to both policy makers and the literature in developing unit/team-based incentive programs that will ensure both productivity and collaboration, as is the case abroad.

Anahtar Kelimeler

• Nurse
• performance
• pay-for-performance payment

Performansa Bağlı Ödeme ve Etkileri: Hemşirelik Perspektifi

Öz

Amaç: Performansa göre ödeme girişimleri, istenen bakım süreçlerini ve sonuçlarını geri ödemeyle uyumlu hale getirerek bakım kalitesini artırmaya çalışmaktadır. Performansa göre ödemenin ana odak noktası daha çok hekimler üzerinde olup hemşireler üzerindeki potansiyel etkisine nispeten daha az önem verilmiştir. Ayrıca, performansa göre ödeme ölçütlerinin hemşirelik bakımı ve süreçleri üzerindeki etkisi çok araştırılmamıştır. Ancak akut bakım ortamlarında, Örneğin COVID 19 Pandemi döneminde, bakım süreçleri ve hasta sonuçları üzerindeki etkisinden dolayı hemşirelikte performansa göre ödeme ölçütlerine olan ilgi artmıştır. Performansa göre ödeme standartları geliştikçe ve hasta sonuçlarını kapsadıkça, hemşirelerin katkıları dikkat çekecektir. Bu çalışma hemşirelere özgü performansa göre ödeme modellerini ve hemşirelere, sağlık sistemlerine olan etkilerini incelemek amacı ile yapılmıştır. Yöntem: Bu amaç doğrultusunda performansa göre ödeme yöntemlerinin sağlık hizmetlerine olan etkileri tartışılmış ve bu konuda yapılan çalışmalar incelenmiştir. Ayrıca hem gelişmiş hem de gelişmekte olan ülkelerde uygulanan performansa göre ödeme modelleri incelenmiştir. Son olarak çalışmada hemşirelere özgü performansa göre ödeme modelleri incelenmiş ve performansa göre ödemenin hemşirelere olan etkileri hakkında yapılan çalışmalara yer verilmiştir. Bulgular: Performansa göre ödemenin sağlık hizmetlerine etkilerine olan genel varsayım, sağlık çalışanlarını ve yöneticilerini üretkenliği ve bakım kalitesini artırmaya motive edeceği ve nihayetinde sağlık sistemini güçlendireceğidir. Performansa göre ödemenin programının başarısı için uygun bir teşvik paketi elzemdir. Bununla birlikte sürdürülebilir ve destekleyici yönetim ve denetim sistemlerinin olması, uygun ekipman, temel ilaçlar ve diğer tıbbi malzemelerin olması programın başarı için gerekli olduğu savunulmaktadır. Hemşirelere özgü geliştirilecek performansa göre ödemenin, hemşirelerin sonuçlardan korkmak yerine olumlu pekiştirme ve ödüller yoluyla mükemmelleşmeye motive oldukları destekleyici bir ortam yaratması önemlidir. Hemşireler hem bireysel hem de ekip içinde birçok görevleri bulunmakta olup performans değerlendireme kriterleri bu görevlerine uygun olarak yapılabilir. Sonuç: Çalışma sonucunda hemşirelere özgü başarılı performansa göre ödeme modelinin geliştirilmesinde dikkat edilmesi gereken konularda önerilerde bulunulmuştur. Özgünlük: Bu çalışma, hemşirelere özgü performansa göre ödeme modellerini ve performansa bağlı ödeme yöntemlerinin hemşirelere, sağlık sistemlerine olan etkilerini kapsamlı bir inceleme sunarak yurt dışında olduğu gibi iş hem verimliliği hem de işbirliğini sağlayacak şekilde ünite/ekip tabanlı teşvik programları geliştirilebilmesi konusunda hem politika yapıcılara hem de literatüre önemli katkı sunmaktadır.

Anahtar Kelimeler

• Hemşire
• performans
• performansa bağlı ödeme

Kaynakça

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