Title

Influence of healthcare organizations’ pay-for-performance initiative on the quality of care

delivered to those with communication disabilities
Introduction and Background
teh quality of sreviceses delivred holds sustnatial importancein the healthcare sector as these
serviceses can direcetly influence the physiala nd psychological helath fp the patinst as well as
their family members. but when it comes to deleivering the helathacre serviceses to those with
the disabilities, there are manay barriers and inevitable chllangeses. giving the quality treatment
to those living with communication disabilities has gained ubstnatial global attention of the
practitioners and the researchers over the lats decade becayse the patainst suffering with such
disabilities are more vulnerable to the poor quality of care. these patinst cannot effecetivley
communicate their condistion nor they can effecetivley take the instsructions by the hetahcare
service providers uch as doctors, nurees etc. anther ereason why thsi area of study has been given
substantial attention is that in year 2013, a report reavealed that about thousand and two hunder
patints who had the communication disabilities died due to the causes which could have been
prevented. it has been shared that such incidents were the reulst of the negligence and absence of
extra care needed by those with disabilities (Barleon, 2013).
there are many reasons why the communication problems between the heltahcare service
providers and the patainst of communication disabilities are occurring and the major problems
include the lack of argumentative and alternative communication skills , ineffective education of
the nures, lak of post graduate education and ineffectiveness in training system (Hemsley,
Balandin, and Worrall, 2012). nurses are haaing adverse attitude towards the patinets having
communication disabilities resulting from the lack of additional incetves offred to them. the
heathacer service providers are not motivated enough to delver the care required by the
patients with such sensitivities and disabilities. it is importnat t take under ocnisderation that,
healthcare organziation’s decisions and Hr initives tend to have direct and signifucantl impact on
motivating the medical and caregiver staff to servie the patinst with disabilities with additional
care and attention (de Bruin, Baan, and Struijs, 2011).

Statement of the problem

the underlying study is based on aporblem that whether the organizational initives to use the
incentive or pay fo erfromance can ahve anay posistve influence on the quality fo are deleivered
to the petinted suffereing with the communication disabilities or not.
Research question
 Can pay-for-performance initiative improve quality of care delivered to those with
communication disabilities in healthcare organizations?

Research hypothesis
Use of Pay-fpr-perfromnce strategy can imrpovete motivation of hlathcare service providres
and can improve the quality fo care proided to patinst with communication didabilities.
Research aim and objectives
Aim
To reveal the relationship between the helath care orgaziation’s Pya for aprefromnce inititive
and quality of helathacre sreviceses offred to patinst with disabilities.
Objectives
 To discuss the role of healthcare organziation’s HR startegis o the quality of care
 to revle the relationship between Pay for perefromnce nititive and improve quality o
care deleivred to communication disabled pataints
 To examine how pay for perfrmncestratgy can mrpove the motivationfheltahacre
service providers
 to reval the impact of pay for perefromnce o prevention of causalities of patinst
suffreiengw ith communication disabilities

Research methodology
 Research design
teh research deigsn is the collection of tsratgies and methdldogies whic are colletiovley
appled for atining the reasrch aim an to answer the research questions. the three ain types of
research deigsn incudes descriptive, casual and exploratory raeserch deisgns. based on the
nature of the resrach topic under discussion, the underling study plans to use the descriptive
research desgn.

 research approach
there are two reserah apparoaches includidng the inductive and deductive reasercha
pproaches. the inductive reasech is used when the underlying study aims to prve the new
throies and new ideas and is conducted at a very large scale. on the other hand, the deductive
raeserch is conducted when the study palsn to prove the existing ideas, concepts and the
ories. as the underying study palns to critically examne the exitsing literature, cmpare
andocntrast the idaesa and prove the extsing studies, thsi study wil icnparte the deductive
approach (Jha, 2008).
research choice
thethree reaserchchoirces includes the qulitaitive, quatiative and mized reserachchoices. the

qualitative research allows the detailed and ocmprensve analysis, wheras eh quantiaive research

allows the decision makaig on the bais of factual information and statistical evidenceses. on the

other han, the mizeda pproah si based on the combine use o qualitative and qunatiative data. the

underlying study will incpoarte the mizeda pproach where both qualititiev and quantitative data
will be oicnporated to examne the pehnomenon in detail, but the qualiatitiev and qunatiataive

data will eb gathered from ony the secondary sources (Ketchen and Bergh, 2006).

 Data collection and collection sources

the raeserch data will be collected only from the secondary sources and no primaray data will be
collected due to the natre of the study. hsi resrach require the detailed examnation and anlaysis
due tow hich the secondary sources will be used and contradictory and critical anlsysi will be
done. this cendray data will be collected from the stehntic cources such as the Book,s Pulished
journal articles, and authentic web sources.
 Data analysis
a critical nd ocmprehnsive literature review will be conducted, which will be based on
comparative analysis of the someocntraditry and some similar pespetives and ideas shared by the
other studies that ahev examined the similar raeserch topics and sytehtis between the fidndinsg
will be fromed.
 Ethical considerations
 teh study is based on ollectinga d analysisng the scendray data, so in order to prevent the
intellectual property theft, the study will icnpoarte the rpoper in-text citataions and a
detailed bilblography will be given at the ed of the report.
 teh study will critically discuss the ideas shared by the altrenatiev studies but during the
anysis no personal information fo the suthors will be evled
 teh persobal bias will be avoided duering the comparatvel analysi of the ideas
 it will be snsured that the data collected for the udnelrying raeserch will be used only for
the reaserch and will not be misused.
Literature Review
the undeleing reaserch aims to reveal relationship between helath care orgaziations’ Pya-for-
paprefromnce strategy and quality ofthe helathacre sreviceses delivered to patinst with
communication disabilities. in this regard, various qualitative and quantitative studies are to b
incorporated and critically analyzed to form a dependable conclusion.

A relevant study can be incorporated which has revealed that the incentives for the better
performance can boost the quality of healthcare and it can be done by the use of various
methods and modes. it has been explained that incentives are designed for the purpose of
motivating and encouraging the healthcare staff to perform well and to improve their medical
outcomes. these incentives could be both non-monetary and monetary incentives and a proper
Pay-for-Performance system can be applied.. it has been further elaborated that when nurse’
performances are compared against the performed indicators, their high performance
outcomes are rewarded and the goal is to encourage the medical staff to live up to the
expectations and the predetermined standards. the monetary and non-monetary rewards boost
the willingness of the medical staff to deliver the excellent quality services which can prevent
he mistakes and can leaves patients of communication disabilities and their families satisfied
(Abduljawad, and Al-Assaf, 2011).
a study conducted in 2005 has proposed that 75% of the American companies are using the
Pay-for-Performance technique to boost the performance and when it comes to the health care
sector the same payment system is used but it is having some drawbacks. it has been
elaborated hat despite the use of Pay-for-Performance, the medical outcomes are not
improving because the care providers are rewarded for the quantity of services instead of the
quality of services. due to increased workloads the medical service providers lack the time and
that lack of time compromises the quality of service delivered to the disabled patients as they
require additional time for better care. the study has not only criticized the current problems in
the American healthcare sector and poor quality of care due to the ineffective use of Pay-for-
Performance system but has also proposed some suggestions. it has been added that a system
based on proper measures, guidelines and quality focused KPI must be used (Rosenthal, Frank,
Li, and Epstein, 2005).
another broader study can be incorporated which has not focused on either normal or disabled
patients but has provided an overall aspects regarding the impact on incentive pay system on
the quality of medical care delivered by nurse and other medical staff members. this study
holds substantial importance as it has based the argument on the primary data. the research
has examined the data shared by 613 hospitals and has revealed that those hospitals which
used the pay-for-performance system significantly improved the quality of healthcare in chronic,
acute and primary care. this study has examined the performance of hospitals over the period
of 2 years and has revealed that hospitals which were engaged in utilizing the pay-for-
performance attained greater improvements into the quality of care an incentives stimulated the
improvements and the programs used by the hospitals out weighted their costs (Lindenauer,
Remus , Roman, Rothberg , Benjamin, Ma, and Bratzler, 2007).
to analyze and anticipate the impact of PIP on the communication and interaction between
nurses and patients with communication defects, some relevant studies can be incorporated
which have focused on analyzing the impact of pay-for-performance on health care outcomes.
one of the relevant studies was conducted in 2011 which has proposed some very interesting and
important ideas. it has been claimed that pay-for-performance helps in improving the disease
management system and improves entire health care system. it can motivate the medical service
provider to serve patients in most effective manner as it offers incentives and payments. this
relevant study has argued that payment model holds substantial importance in improvement of
health care because the financial incentives leaves direct and significant impact on the
performance outcomes of nurses as well as other medical staff members. it has been further
 explained that additional or in some cases reduced payments are paid to nurses based on their
performance outcomes that plays a central role improving communication and it reflects that it
can facilitate those with communication disabilities to gain the best care (de Bruin, Baan, and
Struijs, 2011).
the underlying literature review has adopted a critical and comprehensive approach of exploring
the phenomenon under dicussion. various studies based on both qualitative and quantitative
data have been incorporated and multiple aspcts have been studied that have helped in
examining the infunce of the helath care orgaziations’ pay for perfromnec nitative on the quality
of care deleivred t the patints having communication disabilitie. after the detailed analysis,
several implications have been revealed but there are still some gaps into the literature which
can be addressed by conducting primary research and ist analysis in the future studies.
Chapter 2: Research diary
a) A record
the following gantt chart is representing a record of the tajks preformed in the 6 weeks in which
the project was completed and the reaserch invesgtiations were conducted.
Activities/Tasks Week 1 Week 2 Week 3 Week 4 Week 5 Week 6
Background
information
research
Identification of
research problem

Writing Research
questions

Writing research
hypothesis

Writing research
aim and
objectives 
Literature review

Literature review
Application of
research
methodology
Complete
compliance with
Ethical
considerations
Data Analysis

Conclusion and
recommendations

b) A record and reflection

Wekk 1 and 2
in the first week of the project the background information was reaserch, reseracj rpobel
sttemnet was written and the reaserc questins were formed. the main theme which was sletd to
be anlsed was the helath care for those living with disability and long trem conditions. in Unit 25
an interview was conducted which focused on the organizational influence on the heltahcare
qulity in association with which, the topic for the underlying raeserch was slected. this research
has focused on analysisngtehinflfunce of the helthcar organziations’ pay for perfromnce tsratgy
on the qlaity of care delevred to hose with the communiation disabilities. the area o disability
and long tremc ondistion is quite road and to narrow down the raesrch area, only those with
communication disbalities have been slected for the anlaysis as the communication disbality
directly influce the ability to ecive the quality care as the patinst lacks the ability to share what
they feel, an find dfficultities in undertsnding the communication by the helathacre service
providers due to which the risk of the ineffecetive care increases. after spendidnga lot of time
on slecting the most suitable and more intertig rea of study, a research prolem was identified and
relevanat raeserch questiosn were formed in thi first week.
in the second week the cre hypotheis was identified which is based on an idea that when pay for
perfromnce initives areused, they motivate the helhcre providers to serve well an eneble them to
deleiver he quality care to those who need additional care and attention. after settinga ahypothsis
the next initives was the reaserch aim and obejectives. in thsi week, manay problems were
encountrted becaue it was difficult to breakbrod the core raeserch area into different parts ad to
set some specific, measurable, attainable, realistic and timely objectives.
Week 3 and 4:
in week 3 and 4 comprehnsive literature review was conducted a no other parts of the research
were covered. the literature review was given substantial mportance because the study si was
netireley based on the sceindary data analysi, and critiallya nd ocmprehnsviley analysisng the
ideas an most relevnet information held substantial imprtace to each a cncluson. in the beginning,
the literature review was quite chlalnging as it was hard to identify only authentic sources of
information . the topic of the impact on pay for perfromce on healthcare was easy to raesech as
there were mnay studies abvailbel on it, bt when it cae toa nalse the impact on the helathacre of
patinst with communication disabilities, if was chalalnging to fin out the relevnet stdies. afer a
few days, a sstematci approach was adopted and the literature review was completed. in middle
of the week 4, i started wrking on the raeserch methodldogy and decided the suitable reaserch
deigsn, research approach and research choice.
Week 5 and 6:
after dentifying the reserah deisgn of decsriptipe raeserch, a deductive apaproch and mized
research choice, in week 5 the data collection d analysis desisgsninsg wre made. in the
beginning i decided to use the rpmarya nd scendry data together to gain detailed undertdnding
into the phenoemenon. but it was chalalnging to get the first hand data from the nurses or
helathacre service providers or the patainst with the communication defects in the given time
period, so i ecided to use only scendary data and to adopt a comparative analysis method. after
analysisng the data in the 6 th week, i started working on foringa conclusion. and by the end of
the 6th week, a dependable conclusion was frmed and the futer research recomendadations were
proposed.

Chapter 3: Analysis
a)
i tehrpoposalteh compreheisve an dmpartivle literature review h and analysia nd discussionfo
findings have been proposed as the eveulation techniques. these evlaation tehnqiues are
isgnifucantly relevenet and useful because no primay data has been collected and teh stsudy was
based on only the sceindray data. whe it comes to teh sceindray data analysis, teh bets technique
is teh comparatcve and critical review of teh literature to revel teh usefull incormation and gather
the dependable findings. the study aimed tao analyse and revle teh impact of teh healthcare
organzitaions’s pay fo perfrommace nititive on the quality fo are deevred to tehpatainst with
communication disabilities. the hypothesis was set that usisng tehay for perefromnce by helath
car oraziatiosn poistivley inflfunce the quality of car for those with communication disabilities.
based on tehnature o teh hypotheis that si to be provded true or fales, the scendra data analysi
with the comapartive evaluation of teh findings with discussion and anlaysis was teh most
suitable method.
b)
teh discussion nd alaysi techniques can be apaplied to interpret and to analyse the data and reulst
collected duering teh literature eview to form a dependabl ocnclusison. Lindenauer, Remus ,
Roman, Rothberg , Benjamin, Ma, and Bratzler’s study holds more importance into the study as this
study has incorporated the primary data directly collected from the hospitals. after the detailed analysis
the study has revealed that those hospitals which were using the Pay-for-Performance had more accurate
medical results as compared to those which were not using it. this idea is somewhat similar to the
study shared by O'Halloran, Grohn, and Worrall but the key differentiation is that it has provided a
broader perspective and has focused on chronic, acute as well as primary care. the type of plans
which are referred by this study are very relevant to pay for perfromace plans and according to
which, it can directly improve quality of the healthcare delivered for those who are having some
sort of disability in their communication. de Bruin, Baan, and Struijs also suggested similar idea
but their study has made a different claim as well as it has proposed that payments are
determined based on the performance of nurses and the financial motivator helps in shaping the
nurse’ behavior and attitude towards the disabled patients. on the whole, it has shared that pay-
for-performance improves disease management system and holds the ability to encourage
improvements so that patients could be effectively and efficiently served in the highly effective
and efficient manner due to the incentives and payments offered to them. it is a Pay-for
-Performance system that is based on proper measures and software and sets eth clear goals
due to which nurses could be bund to live up to standards so that they could be remunerated
accordingly. it helps in analyzing the medical staff’s performance in a timely manner and its
quantifiable measures can substantially improve quality of care and in quantifying performance outcomes

through the use of KPIs. the payments are to be determined on the basis of performance and
financial motivator shapes the nurse’ attitude. in addition to this , literature review has revealed
that pay for perfrmnce and incentive ystems can also play part in improving disease
management system and can encourage improvements to attain high effectiveness and efficiency
which can lead to improvement in communication between nurses and their patients with
communication disabilities.
c)
teh study has analysed hwo pay for perfromnce initiive used by helath are organizations can
improve health care service delivered to patients with communication disabilities. thsi study hasa
revled some useful implications which can help the academic researchers and analysts to gain
substantial information from various perspectives and help the healthcare institutions in adopting
the pay for perfromence system as a solution for such communication problems. massive
number of patients having communication disability have died all across the globe in the last
decade and by identifying the technique to responds to that healthcare policies can be improve.
on teh whole, the findings of the research holds significant importance for the academic
researchers, analysts as well as the practitioners but there are still gaps into the literature which
must be filled by teh future research studies based on teh recomendadatiosn blow:

 in order to add authenticity into the argument, the future researchers should focus on
basing the opinions on the actual medical outcomes of hospitals that have adopted the
Py for perfromnce initiative, so that it can be evaluated that how thsi Hr stratgy can
contribute in improving the communication between the healthcare providers and
patients with communication disabilities.
 the future studies must place more focus on evaluating the importance of pay for
perfromnace in improving the communication in the acute hospital settings because the
acute hospitals tend to have more challenging environmental barriers and it can be more
diffuclt to deliver teh quality sreviceses to those with communication impairemnet o
diability.
 the topic must also be analyzed by collecting the primary data so that primary and
secondary data could be synthesized and more dependable conclusion could be formed.

Chapter 4: Peer-to-Peer Viva with Transcript

Due to the rsisng concerns ad extensive attention gvene to the importance of imrpoveing heltha
care seviceses for patinst with didabilities, i have slected thsi area o research to fil th gap into teh
literature. it has been revleved by teh studies that in teh reent years, manay patinst with teh
communication disabilities died dueto some reasons which were cureable and it has been reled
that byfcousisng on impoving teh quality of are deleived to teh patsinst withcommuniation
idbailities, their fatalities can be prevented. due to teh sisgnifucantl importance of the
imrpoevmnet n teh helathacre serviceses delivered tosuch didabled patints, i have fcused on
reveleing how teh helath care oraganistionz’s pay for perefrmnce inititive can lead to anay
possible imrpoevmnets. and i have focused on teh research hypotheis that “Use of Pay-fpr-
perfromnce strategy can imrpovete motivation of hlathcare service providres and can improve
the quality fo care proided to patinst with communication didabilities”. after teh edtailed
examination fo teh literature thsi hypothsi has been proved true as most o teh qualitative and
uqnatiative studies have valued the use of Py for perefromce system for improving teh helatacre
service rpoviders’ levelfo motivation and dedication to give more tuime to those who need
additional care. You all are welcome to ask questions.
Peer 1: Why have you avoided using the firsthand data, don’t you think that could have provided
more accurate information?
No, i belive tehr imaray data can surely provide more accurate information, but only when t is
used in accordance withteh nature fo teh topic under discussion. teh time frame for completing
the research was not enoughto conuct pirmay research, and scedly it was not feasobel t gather
tehinformation from teh patients of communication disabilities regarding how better they felt,
and what was tehri level fo staifaction towards teh sreviec deleivred by helathacer service
providers.
Peer 2: Communication dsbailities are usually a prolem when treting teh children, but you have
not focused on anay example specifically reated to childcar, why?
teh communication disabilities are not limited to children because speech sound disorder,
stuttering , social communication disorder and manay other communication diabilities are also
common in Aults. so i have tried to analyse teh phenomenon froma baoder perspective instead of
focusisng on teh childcare alone.
Peer 3: Cn you give exampleof any hospital or medical institute that has actually implemented
Pay for perfromnec and has attined anay visbale imrpoeing n teh qulaityfo care?
here, i can explain yu the study i hae incorpoarted in literature by Lindenauer, Remus , Roman,
Rothberg , Benjamin, Ma, and Bratzler, 2007. this research has revealed the outcomes of 613
hospitals and those which have used Pay for perfroemnce system and have stimulated quality
fo care and haverecvered their costs.
I Hope you all are satisfied with my ansewers and thsi study has made contribution to your
knowledge. Thank You!