An Incentive-Based and Community Health Worker Package Intervention to Improve Early Utilization of Antenatal Care: Evidence from a Pilot Randomised Controlled Trial.

Objectives One of the factors linked to South Africa's relatively high maternal mortality ratio is late utilization of antenatal care (ANC). Early utilization is especially important in South Africa due to the high HIV prevalence amongst pregnant women. This study examined the impact of a package intervention, consisting of an incentive called the Thula Baba Box (TBB) and a community health worker (CHW) programme, on early utilization of ANC. Methods A pilot randomised controlled trial consisting of 72 women aged 18 and older was conducted in an urban area in South Africa to evaluate the impact of the package intervention. Women were recruited and randomised into either intervention (n = 39) or control group (n = 33). The intervention group received both the TBB and monthly CHW visits, while the control group followed standard clinical practice. Both groups were interviewed at recruitment and once again after giving birth. The outcomes measured are the timing of first ANC visit and whether they attended more than four times. It is anticipated that the box will also have a beneficial impact on infant health outcomes, but these fall out of the scope of this study. Results Women in the intervention groups sought care on average 1.35 months earlier than the control group. They were also significantly more likely to attend at least four antenatal clinic visits. Conclusions for practice Given the South African context and the importance of early care-seeking behaviour to improve health outcomes of HIV-positive pregnant women, the intervention can help to improve maternal and neonatal health outcomes. Further research is needed to investigate the impact of the two interventions separately, and to see if these findings hold in other communities.

Ouality and performance measurement: national efforts to improve quality of care through measurement development.

The US Department of Health and Human Services created the National Quality Strategy to provide a framework to focus providers and organizations in achieving greater impact around better care, healthy people and communites, and affordable care. Providing incentive programs around quality measurement is one mechanism used to achieve these aims. Certified Registered Nurse Anesthetists (CRNAs) should begin to familiarize themselves with the consensus development process used in measurement development and the importance of measurement endorsement through the National Quality Forum. Additionally, CRNAs should become familiar with what Physician Quality Reporting System (PORS) measures CRNAs are currently using in anesthesia and the 2015 payment adjustments one may face if not currently reporting to the PORS.

Avoiding scandal. Recommended practices for board executive compensation committees.

The executive compensation committee walks a fine line between providing competitive executive pay and risking regulatory scrutiny. Here's how you can keep your balance.

Value rules: senior management incentives in the post-option era.

Big changes are in the news and on boardroom agendas. This is a good time for many companies to step back and think fundamentally about how senior management incentives are structured and how these programs should be redesigned for better business results. This article describes the main problems with current incentive structures. It then shows how "value rules" can help employers make better use of incentive plans and create a real stake in business units' long-term results, so that the overall structure of executive incentives consistently encourages value creation for shareholders.

[Prophylaxis and health promotion--whether and for whom they provide profit?]. / Profilaktyka i promocja zdrowia--czy i dla kogo stanowia zysk?

The subject of this article is employee and his family, employer, the state in all aspects and health as a profit and a lack of health as a loss. Healthy employee brings a profit to himself, to the employer and to the state. Up to these times nobody has thought about the health value. Work is a commodity. Prophylaxis and health promotion are work. Health can be sold as each commodity. Prophylaxis and health promotion incur expenses but they must be compared with illness results expenses (including immeasurable ones). Having analysed the literature the author claims that the thesis is right so it means that the effects of prophylaxis and health promotion determine the profit to employees and their families, to employers and to the state--which means to all of us.

Recognition of staff nurse job performance and achievements: staff and manager perceptions.

Recognition for job performance is central to staff nurse morale. However, little research has been done to identify recognition methods most valued by nurses themselves. The authors report results of a multisite survey conducted to compare staff and manager perceptions of meaningful recognition behaviors. They provide data for developing management interventions that may help to improve morale and increase retention. Given the financial constraints of the current environment, the nonmonetary recognition practices identified are of particular significance.

[Motivation and incentives: different perceptions of administrators and professionals. Evaluation Team of the Materno-Infantile Health Program]. / Motivación e incentivos: percepciones diferentes de gestores y profesionales. Equipo de Evaluación del Programa de Salud Materno-Infantil (PSMI).

OBJECTIVE: To find the views of Primary Care District managers and Health Centre (HC) professionals in Andalusia on systems of motivation and incentive in use in this autonomous community. DESIGN: A descriptive study which uses qualitative and quantitative methodology. SETTING: Primary Care districts and Health Centres in Andalusia. PARTICIPANTS: Primary Care district managers (51) and HC professionals (91). MATERIAL AND METHODS: Information-gathering: self-administered questionnaire (managers) and focus groups (professionals). ANALYTICAL TECHNIQUES: Non-parametric tests to compare means and analysis of contents of discourse. Field-work. July 1994 and February 1995. RESULTS: 55% of the district managers thought that the incentive systems in use were inadequate and insufficient. Enabling professionals to be trained is the main motivating and incentive mechanism in place. Variable productivity was the next most common mechanism. However, variable productivity, in the view of the professionals, was the main demotivating factor of recent years. Professionals thought that the economic rewards of the incentives system were slight, the target variables were unsuitable, there were no objective evaluation mechanisms and the economic differences between the incentives earned by managers and professionals were too great. CONCLUSIONS: The District managers indicated that improvements in the incentives systems used are needed. The HC professionals affirmed that the Andalusian incentives system has demotivated Primary Care teams and has had little effect on orienting professional practice.

Fast changes for tough times: employee suggestion programs.

In the midst of the current marketplace's turmoil, healthcare organizations (HCOs) lack two critical commodities: time and money. Today, time and money are all that stand between many HCOs current operations and their demise at the hands of healthcare reform; therefore, healthcare administrators cannot afford to spend either frivolously. Consultants have put forth an array of employee incentive programs designed to address cost containment and market positioning goals of various institutions. Many of these programs are well packaged and can be considered "politically correct" in terms of current philosophies on employee-management relations. However, many programs focus on long-term goals and strategies and, therefore, are most appropriate for organizations not in immediate danger of demise. One long-term program espoused and implemented widely by organizations is the employee suggestion system. This article looks at employee suggestion programs.