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The purpose of this paper is to examine the question of how official bodies, health care organisations, and professional associations deal with the absence of a methodological gold standard for the simultaneous development of clinical practice guidelines and quality indicators, what procedures they use and what they feel are major strengths and limitations of their methods.

The authors conducted a web‐based survey among 90 organisational members of the Guidelines International Network (G‐I‐N) representing 34 countries from Africa, America, Asia, Europe and Oceania. All organisational G‐I‐N members were invited to participate in the survey by following a link provided in the invitation e‐mail.

The responses of 24 organisations were included in the final analysis. The results indicate a broad variability in the approaches and methods used to develop quality indicators and guidelines simultaneously. The answers of the participants indicated a lack of formal procedures for the simultaneous development. Formal procedures exist in only about half of the participating organisations. In addition, piloting or evaluation of the procedures is almost completely missing. Significantly, respondents mainly reported that the procedure used in their organisation “could certainly be more rigorous”. Besides various strengths, participants reported a considerable number of limitations of the development processes they use.

This survey among G‐I‐N members – despite limitations – gives helpful insights in the state of the simultaneous development of quality indicators and clinical practice guidelines and underlines the need for future activities in methodological standard development and quality improvement of these processes.

Pay-for-performance (P4P) as an innovation for improved health care has been introduced in many health systems worldwide. The aim of this article is to apply and refine a specific theoretical angle for the analysis of these reforms, the theoretical frameworks of public policy instruments and programmatic actors, in order to highlight differences between countries.

This analysis is based on a comparative case study of the introduction of P4P in France and Germany in the ambulatory sector for the period from 2007 until 2017. This included a literature review and semi-structured interviews with 23 actors between 2013 and 2015.

The introduction of a supposedly clear-cut policy instrument – P4P in health care – is distinctly shaped by the intertwined configuration of institutional architecture and the policy programme of key system actors. This can be understood as a continuation of long-term transformations, most importantly the increasingly direct influence of the state and a weakening of the representation of the medical profession, as well as an internal fragmentation of the latter.

This analysis illustrates the applicability of the policy instrument approach to the heath sector. In addition, the authors have applied the dual perspective of policy instruments and programmatic actors. Both proved complementary and appropriate for the study of a highly technical instrument such as P4P.