As he and I spoke, Chastain reviewed actual executive compensation plans from a variety of his clients. Many of them are determining executive bonus compensation based on Surgical Care Improvement Project (SCIP) measures, whether the organization exceeded norms on evidence-based medicine follow-through, and other complex measures of quality.
"Right now, I'm looking at two or three pages of really complicated stuff about quality," he says. "It's the right stuff, the quality committees of these boards are getting with the compensation committees on a systematic approach to what they're going after on the quality side. This is much more granular than before. It's not just core measures and patient satisfaction."
Chastain says that around 40% of a health system CEO's, overall compensation can now be tied to these measures, which should be quite enough to align incentives and force executives to do some of the most difficult work in their health systems—improving quality, removing waste, and improving integration.
Breaking down that potential bonus, executives who achieve goals in areas such as their net operating income, patient satisfaction score, a strategic component or two, and safety and quality can receive the full bonus.
Chastain says the most difficult to measure historically, quality and safety, when they were part of the bonus structure in the past at all, were often difficult to measure, and depended on fairly simple metrics. Not anymore.