Challenges of Implementing Pay-for-Performance Plan in the Views of Nurses Working in Hospitals Affiliated to Mashhad University of Medical Sciences: A Qualitative Study

Abstract

Background: Pay-for-performance (PFP) plan is regarded as one of the approaches to increase the efficiency of healthcare organizations. In this respect, indifference to the challenges of implementing the given plan may result in its failure and irreparable damage to health systems. Objectives: The present study aimed at identifying the challenges of implementing the PFP plan in the views of nurses working in hospitals of Mashhad University of Medical Sciences, Iran. Methods: This study was done in the form of qualitative research using a content analysis method conducted in a cross-sectional manner in early 2016. To this end, sampling was of a purposive type and it continued until the data saturation was fulfilled. The participants consisted of 12 men and 17 women with at least 10 years of service, who were selected out of nurses or head nurses working in public hospitals in the city of Mashhad, Iran, as well as nursing experts of the headquarter office of the vice-chancellor for treatment affairs at Mashhad University of Medical Sciences. Data collection was carried out through semi-structured interviews. The content analysis method was employed for data analysis with regard to accuracy, precision, reliability, and consolidation of the data (via triangulation). Results: The results of the study led to the categorization of the data into four main themes and 25 subthemes. The four main themes included structural challenges (10 subthemes), operational challenges (five subthemes), motivational challenges (six subthemes), and biases in decision-making (four subthemes). The theme of structural challenges, among the others, was mentioned as one of the significant factors affecting the implementation of the PFP plan addressed by all study participants. Conclusions: It was concluded that the PFP plan is encountering many challenges in practice; thus, efforts to cope with them could be a big step toward meeting satisfaction in employees and patients. According to the study results, managers are recommended to consider the necessary measures prior to implementing this plan to avoid such challenges as much as possible.