New contract reduces quality of patient-nurse relationship

Mercer, Stewart W; Mcgregor, Wendy

doi:10.1136/bmj.39070.553924.3a

Cited by 6 publications

(4 citation statements)

References 1 publication

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“…Nurses reported more conflict arising from the new style of work: some were positive about the quality and outcomes framework but others reflected views similar to another study, where nurses reported that the new contact had damaged nursepatient relationships and decreased job satisfaction. 21 …”

Section: Alignment Of External Incentives With Professional Valuesmentioning

confidence: 99%

Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study

McDonald

Harrison

Checkland

et al. 2007

BMJ

152

147

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Section: Alignment Of External Incentives With Professional Valuesmentioning

confidence: 99%

Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study

McDonald

Harrison

Checkland

et al. 2007

BMJ

152

147

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show abstract

“…The study therefore corroborates previous research suggesting that the new contract has had a negative impact on nurses' internal motivation 24 and may have altered nurse-patient consultations and job satisfaction. 25 This sample of doctors still believed, as in 2004, that the QOF will have a positive impact on patient health. We found little evidence that nonincentivized conditions were neglected or that doctors' internal motivation was damaged, outcomes feared by the same sample of doctors in 2004.…”

Section: Pay F O R P Er F O R M a Nc Ementioning

confidence: 99%

The Experience of Pay for Performance in English Family Practice: A Qualitative Study

Campbell¹,

McDonald²,

Lester³

2008

The Annals of Family Medicine

138

188

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PURPOSEWe conducted an in-depth exploration of family physicians' and nurses' beliefs and concerns about changes to the family health care service as a result of the new pay-for-performance scheme in the United Kingdom (Quality and Outcomes Framework [QOF]). RESULTS Participants believed the fi nancial incentives had been suffi cient to change behavior and to achieve targets. The fi ndings suggest that it is not necessary to align targets to professional priorities and values to obtain behavior change, although doing so enhances enthusiasm and understanding. Participants agreed that the aims of the pay-for-performance scheme had been met in terms of improvements in disease-specifi c processes of patient care and physician income, as well as improved data capture. It also led to unintended effects, such as the emergence of a dual QOF-patient agenda within consultations, potential deskilling of doctors as a result of the enhanced role for nurses in managing long-term conditions, a decline in personal/relational continuity of care between doctors and patients, resentment by team members not benefi ting fi nancially from payments, and concerns about an ongoing culture of performance monitoring in the United Kingdom. METHODS CONCLUSIONSThe QOF scheme may have achieved its declared objectives of improving disease-specifi c processes of patient care through the achievement of clinical and organizational targets and increased physician income, but our fi ndings suggest that it has changed the dynamic between doctors and nurses and the nature of the practitioner-patient consultation.

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“…13 But this may be masked by many of the QOF tasks being delegated to practice nurses, who take a more negative view. 14 As the financial pressures increase, the position may change, and further evaluation and ethnographic research is needed.…”

mentioning

confidence: 99%

Welcome to the ethics section of theLondon Journal of Primary Care

Zulueta¹

2008

London Journal of Primary Care

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Primary care ethics has acquired a definitive place on the 'bioethics map', now represented by a substantial body of empirical research, literary texts and critical discourse. Primary care ethics does not, on the whole, concern the dramatic or esoteric ethical issues popular in the bioethical journals and the lay press. Instead it is engaged with issues and problems that confront normal individuals in the course of their everyday life. These can be subtle and complex, but are highly relevant to the practice of medicine and the business of living. In fact, much of the empirical research focuses on how primary care practitioners perceive and solve the diverse array of ethical challenges and dilemmas they encounter in the course of their daily work. 1

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New contract reduces quality of patient-nurse relationship

Cited by 6 publications

References 1 publication

Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study

Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study

The Experience of Pay for Performance in English Family Practice: A Qualitative Study

Welcome to the ethics section of theLondon Journal of Primary Care

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