Date of Award

Fall 2019

Document Type

Open Access Dissertation



First Advisor

Abraham Wandersman


The United States has one of the most costly healthcare systems in the world, yet also ranks lower in patient outcomes in comparison with many other developed countries. A focus on quality implementation may help accelerate ongoing efforts to improve healthcare quality. The overall purpose of this study was to explore outcomes-oriented contracting as a mechanism for embedding quality implementation planning proactively into the process for procuring healthcare services. A single case study methodology was utilized to examine changes in procurements over time following implementation of an outcomes-oriented contracting approach within an organization that provides funding for behavioral health and intellectual disabilities services. Findings indicated that the procurements developed using an outcomes-oriented contracting approach included a stronger focus on factors related to quality implementation and outcome evaluation suggesting that this model may facilitate proactive quality implementation planning during the procurement process. Furthermore, interviews with key organization staff shed light into the factors which may facilitate funder use of outcomes-oriented contracting, such as organizational structure, presence of program champions, compatibility, ongoing training and external priorities. Overall, this study provides support for the feasibility of using outcomes-oriented contracting as an approach to building quality implementation planning into the procurement process, and offers a roadmap for future research that explores how to merge quality implementation planning with quality improvement in healthcare.


© 2019, Kassandra A. Alia