Pay for performance: quality- and value-based reimbursement.

There is urgent need to reform health care reimbursement models, including physician compensation, to address high health care costs, despite numerous quality initiatives. Pay for performance (P4P) is a model that attempts to align financial incentives with better outcomes and value rather than the current system of rewarding volume and intensity of care delivered. P4P has been implemented in other countries besides the United States and is perhaps most advanced in the United Kingdom. Measurement for P4P is evolving, as are the types of incentives; neither is perfect at this time. For P4P to succeed, all health care stakeholders will need to collaborate.

Performance evaluation in work settings.

Recent research from 1993 on performance evaluations in work settings is reviewed and integrated with the prior reset and historical bases. Contemporary research reflects several themes: General models of job performance are being developed, the job performance domain is being expanded, research continues to explore the psychometric characteristics of performance ratings, research is developing on potential bias in ratings, rater training is examined, and research continues in terms of efforts to attach utility values to rated performance. We conclude that research is progressing in traditional content areas as well in the exploration of new ground. Researchers are recognizing that job performance is more than just the execution of specific tasks and that it involves a wider array of important organizational activities. There is also an increased optimism regarding the use of supervisory ratings and recognition that such "subjective" appraisal instruments do not automatically translate into rater error or bias.

Subordinate appraisal of managers: a useful tool for the NHS.

Problems in recruiting and retaining professional staff are an ongoing concern to many NHS Trusts and professional heads of service. There is evidence from a wide variety of sources that direct line managers are frequently cited as a source of worker's stress and a cause of staff turnover. Reviews these issues and suggests subordinate appraisal of managers as one possible response.

Dynamic pay initiatives.

In the battle to manage change and deal successfully with health care reform, hospitals are looking to innovative methods to optimize compensation for their executives. Results of the 1993 Hay Hospital Compensation Survey indicate clearly that the pressures of managed care and the uncertainty--but inevitability--of reform are forcing organizations to use new tools and strategies for achieving productivity and quality goals. Another interesting survey finding: Two positions critical to the success of integrated health care systems--the head of medical affairs and the head of managed care--show significant compensation growth during the past two years.