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This paper investigates the behavioural effects of competitive, social-value and social-image incentives on men's and women's allocation of effort in a multi-task environment. Specifically, using two real-effort laboratory tasks, we investigate how competitive prizes, social-value generation and public awards affect effort allocation decisions between the tasks. We find that all three types of incentives significantly focus effort allocation towards the task they are applied in, but the effect varies significantly between men and women. The highest effort distortion lies with competitive incentives, which is due to the effort allocation decision of men. Women exert similar amount of effort across the three incentive conditions, with slightly lower effort levels in the social-image incentivized tasks. Our results inform how and why genders differences may persist in competitive workplaces.

Contracting out of public services, especially ancillary services, has been a key feature of New Public Management since the 1980s. By 2014, more than £100 billion of U.K. public services were being contracted out annually to the private sector. A number of high-profile cases have prompted a debate about the value for money that these contracts provide. Value for money comprises both the cost and the quality of the services. This article empirically tests the contestability and quality shading hypotheses of contracting out in the context of cleaning services in the English National Health Service. Additionally, a new hypothesis of coupling is presented and tested: the effect of contracting of ancillary services on patient health outcomes, using the hospital-acquired infection rate as our measure. Using data from 2010-11 to 2013-14 for 130 National Health Service trusts, the study finds that private providers are cheaper but dirtier than their in-house counterparts.

Background Primary care in England is facing increasing pressure due to the increasing number and complexity of consultations and the declining number of doctors per head of population. The improvement of primary care efficiency and productivity should be a priority, to ensure that future investments in the medical workforce can cope with the increasingly large and complex demand for care. Objectives This paper presents a systematic literature review of studies that define or measure efficiency in primary care in high-income settings. The review of the existing definitions of primary care efficiency and their limitations will inform future research on the measurement of efficiency in primary care in England and its determinants. Methods Literature searches were performed on Embase, Medline, and EconLit in January 2020. The records that passed the screening were reviewed in full text, and data on the study settings, the efficiency definition, and the efficiency analysis were extracted. Results Of the 2590 non-duplicate records retrieved from the searches, 38 papers were included in the analysis. The volume of the literature on primary care efficiency has evolved significantly from the 1980s, with the majority of the published studies focussing on European health systems. The setting most often analysed was primary care centres. Output was usually expressed using measures of primary care utilisation, with or without quality adjustments. Reference to the health outcomes achieved was, however, limited. Inputs were more commonly expressed in labour terms, while the exogenous variables related either to the characteristics of the patient population or the organisation of primary care. While all studies included an analysis of technical efficiency, consideration of allocative or cost efficiency or the determinants of productivity (e.g. technological change, skill mix) was rare. Conclusions The main limitations that future research on primary care efficiency should address relate to the definition of output. Current approaches to measure the impact on health and the multiple dimensions of output are not sufficient to represent the valued output of primary care. In light of the recent changes in the model of primary care delivery in England, future research should also investigate the impact of technological change on productivity and the scope for substitution across staff roles.

Improving efficiency and productivity are key aspects to ensure that general practices in England can meet the needs of a growing population with increasingly demanding and costly healthcare needs. However, current evidence on the efficiency and productivity of general practices is weak, partly due to suboptimal approaches to measure their ‘valued’ output. To overcome this limitation, this paper presents a multi-dimensional framework and indicators of valued output from the healthcare decision-maker’s perspective. We identified existing primary care performance frameworks through a targeted literature review. We reviewed the frameworks and selected the dimensions relating to the impact on patients’ health outcomes, corresponding with the definition of ‘valued’ output from the healthcare decision-maker perspective. For each dimension, we reviewed the National Institute for Health and Care Excellence (NICE) evidence base and guidance on best practice to develop indicators of valued output. Clinical experts and representatives of the main primary care stakeholders reviewed and validated the framework’s comprehensiveness and development process. Based on a review of three existing frameworks, we synthesised a multi-dimensional output framework comprising 13 dimensions for significant primary care-related conditions and services and 51 indicators of valued output. Each indicator of valued output measures a healthcare episode and the resulting impact on patient’s health. The multi-dimensional framework and indicators provide a theoretical tool to improve the measurement of primary care output in economic efficiency and productivity studies. Future research should explore the measurability of the indicators through available datasets and the implementation of the framework through analytical approaches for efficiency measurement.

The difficulty of measuring public services outcome results in governments adopting some quality performance measurements to oversee the standards and characteristics of the presented services. The study empirically tests the theory of performance management and the extent the waiting time policy would result in higher quality service and better health outcomes in 161 trusts in England from 2010/2011 to 2013/2014. The results show that higher waiting admission share has significant adverse effect on quality standards in terms of mortality rate. Moreover, the findings show that shorter range of waiting time is statistically associated with higher patients’ reported heath gains. However, the paper shows evidence of the presence of the output distortions effect of performance management strategy. The study shows that hospitals with lower mean waiting time have significantly higher readmission rate within 28 days of discharge.

Objectives: To model the frequency of 'last minute' cancellations of planned elective procedures in the English NHS with respect to the patient and provider factors that led to these cancellations. Methods: A dataset of 5,288,604 elective patients spell in the English NHS from January 1st, 2007 to December 31st, 2007 was extracted from the Hospital Episode Statistics. A binary dependent variable indicating whether or not a patient had a Health Resource Group coded as S22 – 'Planned elective procedure not carried out' – was modeled using a probit regession estimated via maximum likelihood including patient, case and hospital level covariates. Results: Longer waiting times and being admitted on a Monday were associated with a greater rate of cancelled procedures. Male patients, patients from lower socio-economic groups and older patients had higher rates of cancelled procedures. There was significant variation in cancellation rates between hospitals; Foundation Trusts and private facilities had the lowest cancellation rates. Conclusions: Further research is needed on why Foundation Trusts exhibit lower cancellation rates. Hospitals with relatively high cancellation rates should be encouraged to tackle this problem. Further evidence is needed on whether hospitals are more likely to cancel operations where the procedure tariff is lower than the S22 tariff as this creates a perverse incentive to cancel. Understanding the underlying causes of why male, older and patients from lower socio-economic groups are more likely to have their operations cancelled is important to inform the appropriate policy response. This research suggests that interventions designed to reduce cancellation rates should be targeted to high-cancellation groups.

Purpose - The purpose of this paper is to establish the impact and effectiveness of the national PING! project implemented by a national governing body of sport (NGB) and key public sector partners in England. It establishes lessons learnt and areas to improve future programme development in this area of public sports management. In addition it is also evidencing a new approach to engaging with physical activity and sports development in local communities. Design/methodology/approach - The research study is based on a user survey with 375 respondents and two qualitative ethnographic case studies in two of the eight cities that were involved in the programme. These case studies encompassed 30 individual or group interviews, informal observations and site visits across the two cities. Findings - The research project has identified some of the key factors that lie behind the positive outcomes of the scheme, including a strong sense of participant community, diverse participant profiles, a hidden workplace impact and building an entry point for non-engaged sports participants to sport and physical activity. In addition, lessons have been learnt in terms of future programme management, design and development in this field of informal and recreational sports project. These include strengthening opportunities for sustainable continued participation, sharing information with other NGBs that are beginning to work in this style of delivery and building alternative pathways to the traditional club as an outlet' for novice participants. Research limitations/implications - The study is based in England and is limited to a one year research project. The qualitative case studies were also only conducted in two of the main partner cities. Originality/value - Very few empirical studies have examined this growing trend towards informal table tennis programmes and facilities. Likewise the paper also offers a novel evaluation approach for NGBs to gain richer more insightful depth of research lessons. It is also part of the growing literature that is questioning the foundations of \"traditional sports development\" practice and its associated sphere of public sector activity.

Purpose – The purpose of this paper is to establish the impact and effectiveness of the national PING! project implemented by a national governing body of sport (NGB) and key public sector partners in England. It establishes lessons learnt and areas to improve future programme development in this area of public sports management. In addition it is also evidencing a new approach to engaging with physical activity and sports development in local communities. Design/methodology/approach – The research study is based on a user survey with 375 respondents and two qualitative ethnographic case studies in two of the eight cities that were involved in the programme. These case studies encompassed 30 individual or group interviews, informal observations and site visits across the two cities. Findings – The research project has identified some of the key factors that lie behind the positive outcomes of the scheme, including a strong sense of participant community, diverse participant profiles, a hidden workplace impact and building an entry point for non-engaged sports participants to sport and physical activity. In addition, lessons have been learnt in terms of future programme management, design and development in this field of informal and recreational sports project. These include strengthening opportunities for sustainable continued participation, sharing information with other NGBs that are beginning to work in this style of delivery and building alternative pathways to the traditional club as an outlet' for novice participants. Research limitations/implications – The study is based in England and is limited to a one year research project. The qualitative case studies were also only conducted in two of the main partner cities. Originality/value – Very few empirical studies have examined this growing trend towards informal table tennis programmes and facilities. Likewise the paper also offers a novel evaluation approach for NGBs to gain richer more insightful depth of research lessons. It is also part of the growing literature that is questioning the foundations of “traditional sports development” practice and its associated sphere of public sector activity.

Background Relatively little is known about how scorecards presenting performance indicators influence medication safety. We evaluated the effects of implementing a ward-level medication safety scorecard piloted in two English NHS hospitals and factors influencing these. Methods We used a mixed methods, controlled before and after design. At baseline, wards were audited on medication safety indicators; during the 'feedback' phase scorecard results were presented to intervention wards on a weekly basis over 7 weeks. We interviewed 49 staff, including clinicians and managers, about scorecard implementation. Results At baseline, 18.7% of patients (total n=630) had incomplete allergy documentation; 53.4% of patients (n=574) experienced a drug omission in the preceding 24 h; 22.5% of omitted doses were classified as 'critical'; 22.1% of patients (n=482) either had ID wristbands not reflecting their allergy status or no ID wristband; and 45.3% of patients (n=237) had drugs that were either unlabelled or labelled for another patient in their drug lockers. The quantitative analysis found no significant improvement in intervention wards following scorecard feedback. Interviews suggested staff were interested in scorecard feedback and described process and culture changes. Factors influencing scorecard implementation included 'normalisation' of errors, study duration, ward leadership, capacity to engage and learning preferences. Discussion Presenting evidence-based performance indicators may potentially influence staff behaviour. Several practical and cultural factors may limit feedback effectiveness and should be considered when developing improvement interventions. Quality scorecards should be designed with care, attending to evidence of indicators' effectiveness and how indicators and overall scorecard composition fit the intended audience. 60 references

Background Relatively little is known about how scorecards presenting performance indicators influence medication safety. We evaluated the effects of implementing a ward-level medication safety scorecard piloted in two English NHS hospitals and factors influencing these. Methods We used a mixed methods, controlled before and after design. At baseline, wards were audited on medication safety indicators; during the ‘feedback’ phase scorecard results were presented to intervention wards on a weekly basis over 7 weeks. We interviewed 49 staff, including clinicians and managers, about scorecard implementation. Results At baseline, 18.7% of patients (total n=630) had incomplete allergy documentation; 53.4% of patients (n=574) experienced a drug omission in the preceding 24 h; 22.5% of omitted doses were classified as ‘critical’; 22.1% of patients (n=482) either had ID wristbands not reflecting their allergy status or no ID wristband; and 45.3% of patients (n=237) had drugs that were either unlabelled or labelled for another patient in their drug lockers. The quantitative analysis found no significant improvement in intervention wards following scorecard feedback. Interviews suggested staff were interested in scorecard feedback and described process and culture changes. Factors influencing scorecard implementation included ‘normalisation’ of errors, study duration, ward leadership, capacity to engage and learning preferences. Discussion Presenting evidence-based performance indicators may potentially influence staff behaviour. Several practical and cultural factors may limit feedback effectiveness and should be considered when developing improvement interventions. Quality scorecards should be designed with care, attending to evidence of indicators’ effectiveness and how indicators and overall scorecard composition fit the intended audience.