Target-Setting, Pay for Performance, and Quality Improvement: A Case Study of Ontario Hospitals’ Quality-Improvement Plans

Abstract

This study examines whether difficult targets and quality indicators in executives' pay-for-performance (P4P) plans affect performance. The impact of target-setting and P4P plans on quality improvement in the public sector is unclear. The Ontario government initiated the Quality Improvement Plan (QIP), which requires hospitals to set targets for quality indicators annually and link executive pay to target achievement since 2011. Analyzing Health Quality Ontario's database and hospitals' 2012–2013 QIPs, this study shows greater quality improvement in hospitals with difficult targets than hospitals with easy targets or without assigned targets; however, the positive impact disappears for high-performance hospitals relative to their peers. We find no significant effect of the use of quality indicators in executives' P4P plans on quality improvement. Copyright © 2018 ASAC. Published by John Wiley & Sons, Ltd.