Why doesn't performance pay work?

The NHS is about to embark on the widescale introduction of performance-related pay. A number of recent studies have seriously questioned the efficacy of merit pay. Utilizing the expectancy theory of motivation, explains why performance pay is unlike to motivate NHS staff.     

Provitamin a carotenoid bioavailability:what really matters?

Micronutrient malnutrition, or ?hidden hunger,? afflicts a large part of the world?s population, with vitamin A deficiency among the most prevalent public health problems. Provitamin A carotenoids in plant foods are a source of vitamin A for humans; however, several factors, including species of carotenoids, host status, and effectors of absorption can negatively, positively, or in yet undetermined ways affect the bioavailability of these compounds. Staple foods biofortified with provitamin A carotenoids have shown more efficient bioconversion to retinol than generally observed for vegetables (e. g., 3 - 6 versus 10 - 80 beta-carotene to 1 μg retinol). Staple foods such as maize, rice, and cassava, are generally more accessible than meat or vegetable sources of retinol or provitamin A carotenoids to poor consumers, who are most likely to suffer micronutrient malnutrition. Interdisciplinary teamwork, including plant breeders, nutritionists, government and local agencies, seed companies, and communities, is needed to avail biofortified crops to needy populations. Key steps include developing, validating the nutritional effects of, providing nutrition education concerning, and promoting the use of biofortified crops. Provitamin A carotenoid biofortification of sweet potato, maize, cassava, and rice are at different stages along this continuum. Close linkages between agriculture, nutrition, and health, are essential in the quest to eradicate hunger among the poor.     

Performance measures: are we measuring what matters?

BACKGROUND: The ultimate intent of healthcare performance measures is to improve health status by stimulating improvements to healthcare quality. This report evaluates how well current performance measurement sets address the leading causes of illness and death in the United States, using the Health Plan Employer Data and Information Set (HEDIS) as an example. METHODS: We assessed whether HEDIS measures exist for the leading causes of illness and death according to five commonly used indices: physiologic cause of death, underlying cause of death, disability-adjusted life years, healthcare expenditures, and missed work days. RESULTS: Fewer than one half of the leading causes of morbidity and mortality are addressed by current measures. CONCLUSIONS: The opportunities for using accurate and meaningful measurement for disease prevention and health promotion are substantial, yet this potential remains only partly realized and depends on further expansion of performance measurement efforts.     

Every child mattered in England: but what matters to children?

‘Every Child Matters' under New Labour provided a framework for services for young children's care and education. It was pushed aside by the Conservative-led coalition and replaced by ‘More Great Childcare'. The UK as a signatory to the United Nations Convention on the Rights of the Child, therefore has obligations for legislation, policy and curriculum, specifically with regard to children's rights and participation. On the 25th anniversary of the United Nations Convention of the Rights of the Child, in practice there may be different levels of participation employed to engage children's views in the development of policy about them. This project sets out to ask children about what ‘matters' to them. Ninety finalist Early Childhood Studies students worked as co-researchers in this project. Five themes are discussed highlighting the powerful thoughts and ideas of children. A range of ‘child-friendly’ methods were used to collect data from children including role-play, interviews, drawings and artefacts, and story-telling.     

Productivity-enhancing work innovations: remedies for what ails hospitals?

Prospective pricing, the proliferation of alternative delivery systems, and the demands of third party payers and corporate employers for the containment of health care costs have engendered the keen interest of hospital executives seeking strategies for improving labor productivity. Despite this interest, the relevant literature suggests that few work innovations designed to enhance labor productivity have been implemented in hospitals. This article describes generic versions of four such work innovations--quality circles, union-management committees, autonomous work groups, and gainsharing--and discusses relevant research indicating the types of benefits gained from each and the reasons why some have failed. Each innovation's potential for success in hospitals is evaluated, and suggestions for increasing the effectiveness of each in hospitals is offered.     

The testing effect on skills learning might last 6 months

In a recent study we found that testing as a final activity in a skills course increases the learning outcome compared to spending an equal amount of time practicing. Whether this testing effect measured as skills performance can be demonstrated on long-term basis is not known. The research question was: does testing as a final activity in a cardio-pulmonary resuscitation (CPR) skills course increase learning outcome when assessed after half a year, compared to spending an equal amount of time practicing? The study was an assessor-blinded randomised controlled trial. A convenient sample of 7th semester medical students attending a mandatory CPR course was randomised to intervention course or control course. Participants were taught in small groups. The intervention course included 3.5 h skills training plus 30 min of skills testing. The practice-only control course lasted 4 h. Both groups were invited to a retention assessment of CPR skills half a year later. Participants included 89/180 (50%) of those invited to participate in the study. Mean performance score was 75.9 (SD 11.0) in the intervention group (N = 48) and 70.3 (SD 17.1) in the control group, effect size 0.4. The difference between groups was not statistically significant, P = 0.06. This study suggests that testing as a final activity in a CPR skills course might have an effect on long-term learning outcome compared to spending an equal amount of time practicing the skills. Although this difference was not statistically significant, the identified effect size of 0.4 can have important clinical and educational implications.     

Public-private mix for DOTS implementation: what makes it work?

OBJECTIVE: To compare processes and outcomes of four public-private mix (PPM) projects on DOTS implementation for tuberculosis (TB) control in New Delhi, India; Ho Chi Minh City, Viet Nam; Nairobi, Kenya; and Pune, India. METHODS: Cross-project analysis of secondary data from separate project evaluations was used. Differences among PPM project sites in impact on TB control (change in case detection, treatment outcomes and equity in access) were correlated with differences in chosen intervention strategies and structural conditions. FINDINGS: The analysis suggests that an effective intervention package should include the following provider-side components: (1) orienting private providers (PPs) and the staff of the national TB programme (NTP); (2) improving the referral and information system through simple practical tools; (3) the NTP adequately supervising and monitoring PPs; and (4) the NTP providing free anti-TB drugs to patients treated in the private sector. CONCLUSION: Getting such an intervention package to work requires that the NTP be strongly committed to supporting, supervising and evaluating PPM projects. Further, using a local nongovernmental organization or a medical association as an intermediary may facilitate collaboration. Investing time and effort to ensure that sufficient dialogue takes place among all stakeholders is important to help build trust and achieve a high level of agreement.     

Really governing: what type of work should boards be doing?

Effectiveness is generally defined as "doing the right things." To be effective, boards of health systems and hospitals must have a clear, precise, and shared image of the type of work they should be doing to really govern their organizations. This article forwards a paradigm of board work--the five ultimate responsibilities and three core roles of governance. The paradigm is then employed to discuss the division of responsibilities and roles among boards and their standing committees, and superordinate and subordinate boards in tiered governance situations typical of many multifacility and integrated health care delivery systems.     

The use of work teams: a help or hindrance to performance?

The use of work teams is a popular topic in business literature. Although there is a growing literature on this topic, the team concept is not new to organizations. The article examines historical developments in the use of teams for performance of work. The use of work teams is discussed in the context of the movement away from hierarchical, bureaucratic management structures and toward participative decision making. The benefits of and problems with self-directed teams, in particular, are explored.     

Welfare to work? Impact of maternal health on employment

OBJECTIVES: This study investigated whether health problems among poor mothers of chronically ill children affect their ability to obtain and maintain employment. METHODS: Mothers of children with chronic illnesses were surveyed at clinical and welfare agency sites in San Antonio, Tex. RESULTS: There were distinct health differences according to mothers' TANF and employment status. Mothers without TANF experience reported better physical and mental health and less domestic violence and substance use than did those who had TANF experience. Those not currently working had higher rates of physical and mental health problems. CONCLUSIONS: Poor maternal health is associated with need for cash assistance and health insurance. Policymakers must recognize that social policies promoting employment will fail if they do not address the health needs of poor women and children.     

ADHD and academic performance: why does ADHD impact on academic performance and what can be done to support ADHD children in the classroom?

This paper reviews the relationship between attention deficit hyperactivity disorder (ADHD) and academic performance. First, the relationship at different developmental stages is examined, focusing on pre‐schoolers, children, adolescents and adults. Second, the review examines the factors underpinning the relationship between ADHD and academic underperformance: the literature suggests that it is the symptoms of ADHD and underlying cognitive deficits not co‐morbid conduct problems that are at the root of academic impairment. The review concludes with an overview of the literature examining strategies that are directed towards remediating the academic impairment of individuals with ADHD.