Accountability and Value for Money: A Framework for Exploring the Relationship in Private Finance Initiative Contracts

There is an implicit assumption in the UK Treasury’s publications on public-private partnerships (PPP) – also more commonly known in the United Kingdom as private finance initiative (PFI) - that accountability and value for money (VFM) are related concepts. While recent academic studies on PPP/PFI (from now on as PFI) have focused on VFM, there is a notable absence of studies exploring the ‘presumed’ relationships between accountability and VFM. Drawing on Dubnick’s (Dubnick and Romzek, 1991, 1993; Dubnick, 1996, 1998, 2003, 2005; Dubnick and Justice, 2002) framework for accountability and PFI literature, we develop a research framework for exploring potential relationships between accountability and VFM in PFI projects by proposing alternative accountability cultures, processes and mechanisms for PFI. The PFI accountability model is then exposed to four criteria - warrantability, tractability, measurability and feasibility. Our preliminary interviews provide us guidance in identifying some of the cultures, processes and mechanisms indicated in our model which should enable future researchers to test not only the UK Government’s claimed relationships between accountability and VFM using more specific PFI empirical data, but also a potential relationship between accountability and performance in general.

Analysis of pharmacists attitudes toward a distance learning initiative on health screening

A questionnaire was developed to investigate pharmacists' attitudes to distance learning (DL) as a vehicle for continuing education (CE). It was included in each of a two part DL course on Health Screening. Part One was mailed to all community pharmacists in England (16,400) and returns were received from 1487. The questionnaire in Part Two was returned by 436 pharmacists. Attitude statements were scored using a five-point Likert scale. The mean response to all attitude statements was positive. Participants were significantly more satisfied than non-participants with DL in general and the DL course studied (P less than or equal to 0.05). Over 80 percent of respondents completing the course found DL to be enjoyable and more suitable than other CE methods. More females and less males than expected (based on registration statistics) requested (P less than or equal to 0.001) and completed the course (P less than or equal to 0.001). Pharmacists of all ages participated, although those recently qualified showed greater interest.

AUDIT OF ANTIBIOTIC USAGE IN A MEDIUM-SIZED GENERAL-HOSPITAL OVER AN 11-YEAR PERIOD - THE IMPACT OF ANTIBIOTIC POLICIES

The objective of the present study was to evaluate trends in antibiotic expenditure over an 11-year period (1982-1992) in a 370-bed district general hospital in Northern Ireland and to examine the impact of two separate antibiotic policies on antibiotic usage. A further objective was to examine the attitudes of prescribers to the second policy. Drug utilization review was used to collect information on antibiotic expenditure and usage before and after introduction of separate antibiotic policies in 1985 (not intensively monitored) and 1989 (intensively monitored). A mail questionnaire was used to determine the attitudes of prescribers. The first policy (1985) showed no benefits with regard to the number of antibiotic entities stocked (45 before, 45 after), number of dosage units issued (9.35 increase) or expenditure (33.35 increase). The 1989 policy led to significant reductions in the number of antibiotic entities stocked (28.9%), number of antibiotics issued (11.9%) and expenditure (6.1%). Expenditure began to spiral upwards when active monitoring of the second policy was suspended. The majority of prescribers (87.2%) who responded to the questionnaire (56.5% response rate) felt that the 1989 policy made a positive contribution to antibiotic usage in the hospital.

Using bar-code technology to capture clinical intervention data in a hospital with a stand-alone pharmacy computer system

The use of barcode technology to capture data on pharmacists' clinical interventions is described.