How and why do Quality Circles work for General Practitioners - a realist approach

Objectives: To understand how and why general practitioners in quality circles (QC) reflect on and improve routine practice over time. To provide practical guidance for participants and facilitators to implement and for policy makers to organise this complex social intervention. Design: A theory-driven mixed method Setting: Primary health care Method: We collected data in four stages to develop and refine the programme theory of QCs: 1) co-inquiry with Swiss and European stakeholders to develop a preliminary programme theory; 2) realist review with systematic searches in MEDLINE, Embase, PsycINFO, and CINHAL (1980-2020) to extend the preliminary programme theory; 3) programme refinement through interviews with participants, facilitators, tutors and managers of quality circles; 4) consolidation through interviews and iterative searches for theories enabling us to strengthen the programme theory. Sources of data: The co-inquiry comprised 3 interviews and 3 focus groups with 50 European experts. From the literature search we included 108 papers to develop the literature-based programme theory. In stage 3, we used data from 40 participants gathered in 6 interviews and 2 focus groups to refine the programme theory. In stage 4, five interviewees from different health care systems consolidated our programme theory. Result: Requirements for successful QCs are governmental trust in GPs abilities to deliver quality improvement, training, access to educational material and performance data, protected time, and financial resources. Group dynamics strongly influence success; facilitators should ensure participants exchange knowledge and generate new concepts in a safe environment. Peer interaction promotes professional development and psychological well-being. With repetition, participants gain confidence to put their new concepts into practice. Conclusion: QCs can improve practice, promote professional development, and psychological well-being given adequate professional and administrative support.

Information Disorder Online is an Issue of Information Quality

Issues of information disorder online could be reduced to the issue of information quality: not just about distinguishing truth from falsehood but highlighting, describing legitimate and credible information. “Trustworthiness” is the buzzword in info-quality circles, trending content online should have a signal of the level of ‘trust’ we can place on such content. Social media platforms have recognized the important of signals of trust, for low-quality content to be de-prioritized and high-quality quality content amplified. The algorithms built into a social media platform play an important role in the virality of content online and appear more focused on the quantity of user engagement with content than the quality of the content and the engagement .Information quality is an issue primarily about meaning: the semantic aspects are more relevant than engineering efficiency or grammatical accuracy.

Implementation Fidelity In A Multifaceted Program To Foster Rational Antibiotics Use In Primary Care: An Observational Study

BackgroundThe ARena study (Sustainable Reduction of Antimicrobial Resistance in German Ambulatory Care) is a three-arm, cluster randomized trial to evaluate a multifaceted implementation program in a German primary care setting. In the context of a prospective process evaluation conducted alongside ARena, this study aimed to document and explore fidelity of the implementation program.MethodsThis observational study is based on data generated in a three-wave survey of 312 participating physicians in the ARena program and attendance documentation. Measures concerned persistence of participation in the ARena program and adherence to intervention components (thematic quality circles, e-learning, basic expenditure reimbursements, additional bonus payments and a computerized decision support system). Participants’ views on five domains of the implementation were also measured. Binary logistic and linear regression analyses were used to explore which views on the implementation were associated with participants’ adherence to quality circles and use of additional bonus compensation. ResultsThe analysis of fidelity showed overall high persistence of participation in the intervention components across the three intervention arms (90,1%; 97,9%; 92,9%). 96.4% of planned quality circles were delivered to study participants and, across waves, 30.4% to 93% of practices participated; 56.1% of physicians attended the maximum of four quality circles. 84% of the practices (n=158) with a minimum of one index patient received a performance-based additional bonus payment at least once. In total, bonus compensation was triggered for 51.8% of affected patients. Participation rate for e-learning (a prerequisite for reimbursement of project-related expenditure) covered 90.8% of practices across all intervention arms, with the highest rate in arm II (96.5%). Uptake of expenditure reimbursement was heterogeneous across study arms, with a mean rate of 86.5% (89.1% in arm I, 96.4% in arm II and 74.1% in arm III). Participants’ views regarding participant responsiveness (OR = 2.298) 95% CI [1.598, 3.305] and Context (OR = 2.146) 95% CI [1.135, 4.055] affected additional bonus payment. Participants’ views on participant responsiveness (Beta = 0.718) 95% CI [0.479, 0.957], Context (Beta = 0.323) 95% CI [0.055, 0.590] and Culture of shared decision-making (Beta = -0.334) 95% CI [-0.614, -0.053] affected quality circle attendance.ConclusionThis study showed an overall high fidelity to the implementation program. Participants’ views on the implementation were associated with degree of intervention fidelity. Trial registration: ISRCTN, ISRCTN58150046

CONTROLLING OF TRADE ENTERPRISES IN THE CONTEXT OF THE INTERNATIONAL DIMENSION

The article deals with the features of the controlling implementation in trade enterprises in the context of the international dimension, the possibility of adapting international approaches to the Ukrainian conditions of business. The essential concept of controlling and its connection with realization of the general functions of management is defined. It is established that controlling is a management subsystem that ensures the achievement of the mission and system of goals of the enterprise, covers all areas of activity, business processes and business facilities. It is determined that effective business processes are the driving force of success of a trading company, so the implementation of processes should be monitored and any deviations should be corrected in a timely manner. It was found that the concept of controlling is not limited to pure control. The impossibility of considering controlling only at the final stage of management is substantiated. Controlling ensures the achievement of the goals of trade networks, directing the functioning of the management system of trade entrepreneurs in a single direction, defined by strategic, tactical and operational plans. The experience of other countries in controlling conducting at trade enterprises is studied. The tools of foreign practice that can be used in the implementation of controlling of different areas (marketing controlling, procurement and logistics controlling, financial activities controlling, sales controlling, financial activities controlling) are defined: kaizen system, Just-in-time system, CRM, benchmarking, ABS-analysis and XYZ-analysis, PIMS, outsourcing matrix, DPS method, profitability chart «Maisigma», PEST-analysis, Monte Carlo method, methodology of «quality circles», sensitivity analysis, construction of a map of strategic groups, quality standards, performance indicators, calculation of inventory levels, comparison of costs in the value chain, change management, management of «weak» signals, hierarchy of strategies, building a map of business processes. Implementation of controlling provides an increase in trade to 25%; increase in profit from 10 to 12%; increase in profitability from 8 to 20%; increase labor productivity to 30%.