Al-Katheeri Huda, El-Jardali Fadi, Ataya Nour, Abdulla Salem Noura, Abbas Badr Nader, Jamal Diana
Healthcare Quality and Patient Safety Department, Ministry of Public Health, PO Box 42, Doha, Qatar.
Department of Health Management and Policy, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
Int J Qual Health Care. 2018 Apr 1;30(3):219-226. doi: 10.1093/intqhc/mzy006.
Despite their use worldwide, strategy-based performance management is limited in the Eastern Mediterranean Region. This article explores Qatar's experience, the first from the Region, in implementing contractual agreements between healthcare providers and the regulator-Ministry of Public Health-to align strategy, performance and accountabilities.
mixed-methods including tools development and pilot-testing, guided by performance management cycle with a focus on knowledge translation and key principles: feasibility; mandatory participation; participatory approach through Steering Committee.
All public, private and semi-governmental hospitals and primary healthcare centers.
INTERVENTION(S): (i) semi-structured interviews; (ii) review of 4982 indicators; (iii) Delphi technique for selecting indicators with > 80% agreement on importance and > 60% agreement on feasibility; (iv) capacity-building of providers and Ministry staff and 2-month pilot assessed by questionnaire with indicators scoring > 3 considered valid, reliable and feasible; and (v) 1-year grace period assessed by questionnaire.
MAIN OUTCOME MEASURE(S): Approach strengths and challenges; Data collection and healthcare quality improvements.
Contracts mandate reporting 25 hospital and 15 primary healthcare indicators to the regulator, which delivers confidential benchmarking reports to providers. Scorecards were discussed with the regulator for evidence-informed policymaking. The approach uncovered system-related challenges and learning for public and private sectors: providers commended the participatory approach (82%) and indicated that contracts enabled collecting valid and timely data (64%) and improved healthcare quality (55%).
This experience provides insights for countries implementing performance management, responsive regulation and public-private partnerships. It suggests that contractual agreements can be useful, despite their mandatory nature, if clear principles are applied early on.
尽管基于战略的绩效管理在全球范围内得到应用，但在东地中海区域其应用仍较为有限。本文探讨了卡塔尔作为该区域首个实施医疗服务提供者与监管机构——公共卫生部之间的契约协议，以协调战略、绩效和问责制的经验。
采用混合方法，包括工具开发和试点测试，以绩效管理周期为指导，重点关注知识转化和关键原则：可行性；强制参与；通过指导委员会采用参与式方法。
所有公立、私立和半政府医院及初级医疗保健中心。
（i）半结构化访谈；（ii）审查4982项指标；（iii）采用德尔菲技术选择重要性达成>80%共识且可行性达成>60%共识的指标；（iv）对提供者和卫生部工作人员进行能力建设，并通过问卷对为期2个月的试点进行评估，指标得分>3被视为有效、可靠且可行；以及（v）通过问卷对为期1年的宽限期进行评估。
方法的优势和挑战；数据收集和医疗质量改善。
契约要求向监管机构报告25项医院指标和15项初级医疗保健指标，监管机构向提供者提供保密的基准报告。与监管机构讨论了记分卡，以进行循证决策。该方法揭示了公共和私营部门与系统相关的挑战和经验教训：提供者称赞参与式方法（82%），并表示契约能够收集有效和及时的数据（64%），并改善医疗质量（55%）。
这一经验为实施绩效管理、适应性监管和公私伙伴关系的国家提供了见解。这表明，尽管契约具有强制性，但如果尽早应用明确的原则，可能会很有用。
