Running Head: Name of Main subject

[Research project]

[Student Name]

[University Name]

[Date]
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TABLE OF CONTENTSChapter 1: Research proposal and literature review......Error: Reference

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Research Proposal................................................................... Error: Reference source not found

Title......................................................................................Error: Reference source not found
Introduction and Background.............................................. Error: Reference source not found
Statement of the problem.....................................................Error: Reference source not found
Research question................................................................ Error: Reference source not found
Research hypothesis.............................................................Error: Reference source not found
Research Aim.......................................................................Error: Reference source not found
Objectives............................................................................ Error: Reference source not found
Research methodology.........................................................Error: Reference source not found
Research design................................................................... Error: Reference source not found
Research approach...............................................................Error: Reference source not found
Research choice................................................................... Error: Reference source not found
Data collection and collection sources................................ Error: Reference source not found
Data analysis........................................................................Error: Reference source not found
Ethical considerations..........................................................Error: Reference source not found
Literature Review....................................................................Error: Reference source not found
Chapter 2: Research diary...........................................................Error: Reference source not found
A record...................................................................................Error: Reference source not found
A record and reflection............................................................Error: Reference source not found
Week 1 and 2....................................................................... Error: Reference source not found
Week 3 and 4:...................................................................... Error: Reference source not found
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Chapter 3: Analysis.....................................................................Error: Reference source not found
Demonstration of proposal evaluation techniques as relevant Error: Reference source not found
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Recommendations and justification.........................................Error: Reference source not found
Chapter 4: Peer-to-Peer Viva with Transcript.............................Error: Reference source not found
 Research project ii

Transcript.................................................................................Error: Reference source not found

Chapter 1: Research proposal and literature review

a) Research Proposal

Title

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

delivered to patients with communication disabilities

Introduction and Background

The quality of services delivered holds substantial importance in the health care sector as these

services can directly influence the physical and psychological health of the patients as well as

their family members. But when it comes to delivering the health care services to those with the

disabilities, there are many barriers and inevitable challenges. Giving the quality treatment to

those living with communication disabilities has gained substantial global attention of the

practitioners and the researchers over the last decade because the patients suffering with such

disabilities are more vulnerable to the poor quality of care. These patients cannot effectively

communicate their condition nor they can effectively take the instructions by the health care

service providers such as doctors, nurses etc. Another reason why this area of study has been

given substantial attention is that in year 2013, a report revealed that about thousand and two

hundred patients who had the communication disabilities died due to the causes which could

have been prevented. It has been shared that such incidents were the result of the negligence and

absence of extra care needed by those with disabilities (Barleon, 2013).

 Research project iii

There are many reasons why the communication problems between the health care service

providers and the patients of communication disabilities are occurring and the major problems

include the lack of argumentative and alternative communication skills, ineffective education of

the nurses, lack of post graduate education and ineffectiveness in training system (Hemsley,

Balandin, and Worrall, 2012; Nouwens, van Lieshout, Bouma, Braspenning, and Wensing,

2014; Tay, Ang, and Hegney, 2012). Health care service providers are having adverse attitude

towards the patients having communication disabilities resulting from the lack of additional

incentives offered to them. The health care service providers are not motivated enough to deliver

the care required by the patients with such sensitivities and disabilities. It is important to take

under consideration that, health care organizations’ decisions and HR initiatives tend to have

direct and significantly impact on motivating the medical and caregiver staff to serve the patients

with disabilities with additional care and attention (de Bruin, Baan, and Struijs, 2011).

Statement of the problem

The underlying study is based on a problem that whether the organizational initiatives to use the

incentive or pay of performance can have any positive influence on the quality of care delivered

to the patients suffering with the communication disabilities or not.

Research question

Can pay-for-performance initiative improve quality of care delivered to those with

communication disabilities in health care organizations?

Research hypothesis
 Research project iv

Use of Pay for performance strategy can improve the motivation of health care service providers

and can improve the quality of care provided to patients with communication disabilities.

Research aim and objectives

Aim

To reveal the relationship between the health care organizations’ Pay for performance initiative

and quality of health care services offered to patients with disabilities.

Objectives

 To discuss the role of health care organizations’ HR strategies in the quality of care

 To reveal the relationship between Pay for performance initiative and improved

quality of care delivered to communication disabled patients

 To examine how pay for performance strategy can improve the motivation of health

care service providers

 To reveal the techniques of implementing pay for performance initiative to stay

responsive towards those suffering with communication disabilities

Research methodology

Research design

The research deigns is the collection of strategies and methodologies which are collectively

applied for attaining the research aim and to answer the research questions. The three main types

of research deigns includes descriptive, casual and exploratory research designs. Based on the
 Research project v

nature of the research topic under discussion, the underling study plans to use the descriptive

research design (Kumar, 2005). 

Research approach

There are two research approaches including the inductive and deductive research approaches.

The inductive research is used when the underlying study aims to prove the new theories and

new ideas and is conducted at a very large scale (Denscombe, 2009). On the other hand, the

deductive research is conducted when the study plans to prove the existing ideas, concepts and

theories. As the underlying study plans to critically examine the existing literature, compare and

contrast the ideas and prove the existing studies, this study will incorporate the deductive

approach (Jha, 2008).

Research choice

The three research choices include the qualitative, quantitative and mixed research choices. The

qualitative research allows the detailed and comprehensive analysis, whereas the quantitative

research allows the decision making on the basis of factual information and statistical evidences

(Jankowicz, 2005; Maylor, and Blackman, 2005). On the other hand, the mixed approach is

based on the combine use of qualitative and quantitative data. The mixed approach is most useful

as it can deliver the benefits of both qualitative and quantitative studies and can prevent many

discrepancies. The underlying study will incorporate the mixed approach where both qualitative

and quantitative data will be incorporated to examine the phenomenon in detail, but the

qualitative and quantitative data will be gathered from only the secondary sources (Ketchen and

Bergh, 2006).
 Research project vi

Data collection and collection sources

The research data will be collected only from the secondary sources and no primary data will be

collected due to the nature of the study. This research requires the detailed examination and

analysis due to which the secondary sources will be used and contradictory and critical analysis

will be done (Scruggs, and Mastropieri, 2006; Saunders, Saunders, Lewis, and Thornhill, 2011).

This secondary data will be collected from the authentic sources such as the Books Published

journal articles, and authentic web sources (Ketchen and Bergh, 2006).

Data analysis

A critical and comprehensive literature review will be conducted, which will be based on

comparative analysis of the some contradictory and some similar perspectives and ideas shared

by the other studies that have examined the similar research topics. After the detailed analysis a

synthesis between the findings will be formed (Kothari, 2004).

Ethical considerations

 The study is based on collecting and analysing the secondary data, so in order to prevent

the intellectual property theft, the study will incorporate the proper in-text citations and a

detailed bibliography will be given at the end of the report (Beri, 2013). 

 The study will critically discuss the ideas shared by the alternative studies but during the

analysis no personal information of the authors will be revealed.

 The personal bias will be avoided during the comparative analysis of the ideas.

 It will be ensured that the data collected for the underlying research will be used only for

the research and will not be misused.

 Research project vii

b) Literature Review

The underlying research aims to reveal relationship between health care organizations’ Pay-for-

performance strategy and quality of the health care services delivered to patients with

communication disabilities. In this regard, various qualitative and quantitative studies are to be

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 health care 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 health care 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 to gain the desired results. It has been further

elaborated that when health care service providers’ performances are compared against the

performed indicators, their high performance outcomes are rewarded. The goal behind this

practice 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 the mistakes and can make 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 that

despite the use of Pay for Performance, the medical outcomes are not improving because the care
 Research project viii

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

health care 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 Key performance indicators (KPI) must be used

(Rosenthal, Frank, Li, and Epstein, 2005).

Another broader study can be incorporated which has not focused on both normal or disabled

patients but has provided an overall aspects regarding the impact of incentive pay system on the

quality of medical care delivered by medical service providers such as nurses etc. 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 health care 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 and incentives stimulated the

improvements and the programs used by the hospitals out weighted their costs. The findings of

this study can support the research hypothesis as it has clearly revealed the importance of using

pay for perfromnce for improving the quality of care (Lindenauer, Remus , Roman, Rothberg ,

Benjamin, Ma, and Bratzler, 2007).

To analyze and anticipate the impact of Pay for performance strategy on the communication and

interaction between health care service providers and patients with communication disabilities,
 Research project ix

some more relevant studies can be incorporated which have focused on analyzing the impact of

pay-for-performance on health care outcomes (Needleman, and Hassmiller, 2009; Norouzinia,

Aghabarari, Shiri, Karimi, and Samami, 2016). 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 leave 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 discussion. Various studies based on both qualitative and quantitative

data have been incorporated and multiple aspects have been studied that have helped in

examining the influence of the health care organizations’ pay for performance initiative on the

quality of care delivered to the patients having communication disabilities. 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 its analysis in the future studies.

Chapter 2: Research diary

a) A record
 Research project x

The following Gantt chart is representing a record of the tasks preformed in the 6 weeks in which the

project was completed and the research investigations 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
 Research project xi

Ethical
considerations

Data Analysis

Conclusion and
recommendations

b) A record and reflection

Week 1 and 2:

In the first week of the project the background information was researched, research problem

statement was written and the research questions were formed. The main theme which was

selected to be analysed was the health care for those living with disability and long term

conditions. In Unit 25 an interview was conducted which focused on the organizational

influence on the health care quality in association with which, the topic for the underlying

research was selected. This research has focused on analysing the influence of the health care

organizations’ pay for performance strategy on the quality of care delivered to those with the

communication disabilities. The area of disability and long term condition is quite broad and to

narrow down the research area, only those with communication disabilities have been selected

for the analysis as the communication disability directly influence the ability to receive the

quality care as the patients lacks the ability to share what they feel, and face difficulties in

understanding the communication by the health care service providers due to which the risk of

the ineffective care increases. After spending lot of time on selecting the most suitable and more
 Research project xii

interesting area of study, a research problem was identified and relevant research questions were

formed in the first week.

In the second week the clear hypothesis was identified which is based on an idea that when pay

for performance initiatives are used, they motivate the health care providers to serve well and

enable them to deliver the quality care to those who need additional care and attention. After

setting a hypothesis the next initiative was the research aim and objectives. In this week, many

problems were encountered because it was difficult to breakdown the core research area into

different parts and to set some specific, measurable, attainable, realistic and timely objectives.

Week 3 and 4:

In week 3 and 4 comprehensive literature review was conducted and no other parts of the

research were covered. The literature review was given substantial importance because the study

was entirely based on the secondary data analysis, and critically and comprehensively analysing

the ideas and most relevant information held substantial importance to reach a conclusion. In the

beginning, the literature review was quite challenging as it was hard to identify only authentic

sources of information. The topic of the impact on pay for performance on health care was easy

to research as there were many studies available on it, but when it came to analyze the impact on

the health care of patients with communication disabilities, it was challenging to find out the

relevant studies. There were very few studies that particularly focused on impact of Pay for

Performance on improving the quality of care delivered to patients suffering with the

communication disabilities. After a few days, a systematic approach was adopted and the

literature review was completed. In middle of the week 4, I started working on the research

methodology and decided the suitable research deigns, research approach and research choice.
 Research project xiii

When deciding the suitable methodology, I faced some confusions due tow which I consulted the

instructor and also discussed with fellows because any mistake in selecting the methodology

could have compromised the quality of research findings.

Week 5 and 6:

After identifying the research design of descriptive research, a deductive approach and mixed

research choice, in week 5 the data collection and analysis were made. In the beginning I decided

to use the primary and secondary data together to gain detailed understanding into the

phenomenon. But it was challenging and almost impossible to get the first hand data from the

nurses or health care service providers or the patients with the communication defects in the

given time period. In addition to this, the topic under discussion was a significantly broad topic,

and the primary outcomes gathered from few research respondents were not likely to represent

such a large population. So I decided to use only secondary data and to adopt a comparative

analysis and discussion method to compare and contrast the alternative ideas and perspectives.

After analysing the data in the 6th week, I started working on forming a conclusion by

considering answers for predetermined research question and the attainment of research

objectives. And by the end of the 6th week, a dependable conclusion was formed and the future

research recommendations were proposed.

Chapter 3: Analysis

a) Demonstration of proposal evaluation techniques as relevant

In the proposal the comprehensive and comparative literature review, analysis and discussion of

findings have been proposed as the evaluation techniques. These evaluation techniques are
 Research project xiv

significantly relevant and useful because no primary data has been collected and the study was

based on only the secondary data. When it comes to the secondary data analysis, the best

technique is the comparative and critical review of the literature to reveal the useful information

and gather the dependable findings. The study aimed to analyse and reveal the impact of the

health care organizations’ pay of performance initiative on the quality of care delivered to the

patients with communication disabilities. The hypothesis was set that using the Pay for

Performance by health care organizations positively influence the quality of care for those with

communication disabilities. Based on the nature of the hypothesis that is to be provided true or

false, the secondary data analysis with the comparative evaluation of the findings with discussion

and analysis was the most suitable method. This was a very broad topic and required

comprehensive analysis and discussion before proposing any conclusion, so collection of data

from a small sample could have comprised the dependable conclusion, so the selected approach

of secondary data analysis was most appropriate choice available.

b) Use of evaluation techniques

The discussion and analysis techniques can be applied to interpret and to analyse the data and

result collected during the literature review to form a dependable conclusion. 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
 Research project xv

for performance plans and according to which, it can directly improve quality of the health care

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 health care service

providers and the financial motivator helps in shaping the service providers’ behaviour 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 the 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 Key performance indicators (KPIs). The payments are to be determined on the basis of

performance and financial motivator shapes the service providers’ attitude. In addition to this,

examination of many other studies in the literature review has revealed that pay for performance

and incentive systems 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) Recommendations and justification

The study has analysed how pay for performance initiative used by health are organizations can

improve health care service delivered to patients with communication disabilities. This study has
 Research project xvi

revealed some useful implications which can help the academic researchers and analysts to gain

substantial information from various perspectives and help the health care institutions in

adopting the pay for performance 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 health care policies can be

improves. On the 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 the future research studies based on the recommendations

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

Pay for performance initiative, so that it can be evaluated that how this Human resource

strategy can contribute in improving the communication between the health care

providers and patients with communication disabilities.

 The future studies must place more focus on evaluating the importance of pay for

performance 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

difficult to deliver the quality services to those with communication impairment or

disability.

 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

 Research project xvii

Transcript

Due to the rising concerns and extensive attention given to the importance of improving health

care services for patients with disabilities, I have selected this area of research to fill the gap into

the literature. It has been revealed by the studies that in the recent years, many patients with the

communication disabilities died due to some reasons which were curable and it has been

revealed that by focussing on improving the quality of are delivered to the patients with

communication disabilities, their fatalities can be prevented. Due to the significant importance of

the improvement in the health care services delivered to such disabled patients, I have focused on

revealing how the health care organizations’ Pay for Preference initiative can lead to any

possible improvements. And I have focused on the research hypothesis that “Use of Pay for

performance strategy can improve motivation of health care service providers and can improve

the quality of care provided to patients with communication disabilities”. After the detailed

examination of the literature this hypothesis has been proved true as most of the qualitative and

quantitative studies have valued the use of Pay for performance system for improving the health

care service providers’ level motivation and dedication to give more time 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 believe the primary data can surely provide more accurate information, but only when it is

used in accordance with the nature of the topic under discussion. The time frame for completing

the research was not enough to conduct primary research, and secondly it was not feasible to

gather the information from the patients of communication disabilities regarding how better they
 Research project xviii

felt, and what was their level of satisfaction towards the service delivered by health care service

providers. So in the available resources, the secondary data analysis was the most suitable

research method.

Peer 2: Communication disabilities are usually a problem when treating the children, but you

have not focused on any example specifically related to childcare, why?

The communication disabilities are not limited to children because speech sound disorder,

stuttering, social communication disorder and many other communication disabilities are also

common in Adults. So I have tried to analyse the phenomenon from broader perspective instead

of focussing on the childcare alone.

Peer 3: Can you give example of any hospital or medical institute that has actually implemented

Pay for performance and has attained any visible improvement in the quality of care?

Here, I can explain you the study I have incorporated 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 performance system and have stimulated

quality of care for patients with communication disabilities and have recovered their costs.

I hope you all are satisfied with my answers and this study has made contribution to your

knowledge. Thank You!

 Research project xix

Harvard Formatted

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 Research project xx

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Research project 22