Search

Background The Quality and Outcomes Framework (QOF) is an incentive scheme for general practice, which was introduced across the UK in 2004. The Quality and Outcomes Framework is one of the biggest pay for performance (P4P) scheme in the world, worth £691 million in 2016/17. We now know that P4P is good at driving some kinds of improvement but not others. In some areas, it also generated moral controversy, which in turn created conflicts of interest for providers. We aimed to undertake a meta-synthesis of 18 qualitative studies of the QOF to identify themes on the impact of the QOF on individual practitioners and other staff. Methods We searched 5 electronic databases, Medline, Embase, Healthstar, CINAHL and Web of Science, for qualitative studies of the QOF from the providers’ perspective in primary care, published in UK between 2004 and 2018. Data was analysed using the Schwartz Value Theory as a theoretical framework to analyse the published papers through the conceptual lens of Professionalism. A line of argument synthesis was undertaken to express the synthesis. Results We included 18 qualitative studies that where on the providers’ perspective. Four themes were identified; 1) Loss of autonomy, control and ownership; 2) Incentivised conformity; 3) Continuity of care, holism and the caring role of practitioners’ in primary care; and 4) Structural and organisational changes. Our synthesis found, the Values that were enhanced by the QOF were power, achievement, conformity, security, and tradition. The findings indicated that P4P schemes should aim to support Values such as benevolence, self-direction, stimulation, hedonism and universalism, which professionals ranked highly and have shown to have positive implications for Professionalism and efficiency of health systems. Conclusions Understanding how practitioners experience the complexities of P4P is crucial to designing and delivering schemes to enhance and not compromise the values of professionals. Future P4P schemes should aim to permit professionals with competing high priority values to be part of P4P or other quality improvement initiatives and for them to take on an ‘influencer role’ rather than being ‘responsive agents’. Through understanding the underlying Values and not just explicit concerns of professionals, may ensure higher levels of acceptance and enduring success for P4P schemes.

The aim of this study was to assess the effectiveness of an evaluation instrument using the retrospective pretest design to measure changes in participants' behaviour after library training. This article focuses on the measurement component of training evaluation — the process of answering the question of how much change has occurred. Participants, who were from a large, public academic geriatric care centre in Toronto, included administrators, researchers, clinical and other staff, and university students doing field placements at the hospital. Participants attended one of four 1-hour sessions on the topic of Effectively Searching Google and Google Scholar that were held over a 3-month period. Sixty days post training, a self-administered retrospective pretest questionnaire, consisting of 10 searching behaviour statements developed using the learning objectives for the training session, was used to measure the impact of library training on participants' behaviour. Participants were asked to indicate their level of frequency of performing a searching behaviour described in the statement before and after training using a five-point, Likert-type scale ranging from 1, almost never; 2, seldom; 3, about half the time; 4, often; to 5, almost always. Summary baseline statistics are reported for respondents who never or rarely exhibited the behaviour prior to training. For the change measure, we report the simple percentage of respondents who improved. The findings of this study showed the potential of using the retrospective pretest to help librarians document the outcomes of library training. The benefits of gathering data using the retrospective pretest are discussed.

The purpose of this survey was to explore the attitudes of hospital library managers toward the use of library volunteers. During April 2003 a questionnaire was mailed to 89 Ontario hospital library managers. One of the methods used to assess attitudes toward volunteers was to ask respondents to list two main benefits and pitfalls of using volunteers. Benefits of volunteer use identified by respondents included assisting with routine clerical tasks, saving staff time, providing an added value or service, assisting with a heavy workload, contributing to a positive public perception and promoting library service, keeping costs down, optimizing staff time, and doing special projects. Some of the pitfalls of volunteer use identified by respondents included unreliable volunteer attendance and commitment, and excessive training and retraining. The identification of volunteer benefits and pitfalls will help hospital library managers optimize the use of volunteers and implement changes in the way they manage volunteers.

Seventy hospitalized women were entered into an open, randomized, parallel study of antimicrobial prophylaxis for abdominal and vaginal hysterectomy with the use of either cefotetan, a new long-acting cephalosporin, or cefoxitin. Ninety-four percent of cefotetan recipients and 83% of cefoxitin recipients did not develop clinical signs or symptoms of infection. The satisfactory bacteriologic response rates were significantly different: 91% satisfactory (43 of 47 patients) for cefotetan and 74% satisfactory (17 of 23 patients) for cefoxitin. The two treatment groups demonstrated no significant differences in postoperative temperature changes, duration of hospitalization, or grading of surgical wounds. Neither drug was associated with significant side effects.