Provider diversity in the NHS: impact on quality and innovation

The overall objective of the research project has been to assess the impact of provider diversity on quality and innovation in the NHS. The specific research aims were to identify the differences in performance between non-profit Third Sector organisations, for-profit private enterprises, and incumbent public sector institutions within the NHS as providers of health care services, as well as the factors that affect the entry and growth of new private and Third Sector providers. The study used both qualitative and quantitative methods based on case studies of four Local Health Economies (LHEs). Qualitative methods included documentary analysis and interviews with key informants and managers of both commissioning and provider organisations. To provide a focus to the study, two tracer conditions were followed: orthopaedic surgery and home health care for frail older people. In the case of hospital inpatient care, data on patient characteristics were also collected from the HES database. The analysis of this data provided preliminary estimates of the effects of provider type on quality, controlling for client characteristics and case mix. In addition, a survey of patient experience in diverse provider organisations was analysed to compare the different dimensions of quality of provision of acute services between incumbent NHS organisations and new independent sector treatment centres. The research has shown that, in respect of inpatient hospital services, diverse providers supply health services of at least as good quality as traditional NHS providers, and that there is ample opportunity to expand their scale and scope as providers of services commissioned by the NHS. The research used patient experience survey data to investigate whether hospital ownership affects the quality of services reported by NHS patients in areas other than clinical quality. The raw survey data appear to show that private hospitals provide higher quality services than the public hospitals. However, further empirical analysis leads to a more nuanced understanding of the performance differences. Firstly, the analysis shows that each sector offers greater quality in certain specialties. Secondly, the analysis shows that differences in the quality of patients’ reported experience are mainly attributable to patient characteristics, the selection of patients into each type of hospital, and the characteristics of individual hospitals, rather than to hospital ownership as such. Controlling for such differences, NHS patients are on average likely to experience a similar quality of care in a public or privately-run hospital. Nevertheless, for specific groups of patients and for specific types of treatments, especially the more straightforward ones, the private sector provides an improved patient experience compared to the public sector. Elsewhere, the NHS continues to provide a high quality service and outperforms the private sector in a range of services and for a range of clients.

Improvement of link failure restoration utilising multi-protocol label switching (MPLS) as a means to maintain quality of service (QOS)

This paper proposes a practical approach to the enhancement of Quality of Service (QoS) routing by means of providing alternative or repair paths in the event of a breakage of a working path. The proposed scheme guarantees that every Protected Node (PN) is connected to a multi-repair path such that no further failure or breakage of single or double repair paths can cause any simultaneous loss of connectivity between an ingress node and an egress node. Links to be protected in an MPLS network are predefined and a Label Switched path (LSP) request involves the establishment of a working path. The use of multi-protection paths permits the formation of numerous protection paths allowing greater flexibility. Our analysis examined several methods including single, double and multi-repair routes and the prioritization of signals along the protected paths to improve the Quality of Service (QoS), throughput, reduce the cost of the protection path placement, delay, congestion and collision. Results obtained indicated that creating multi-repair paths and prioritizing packets reduces delay and increases throughput in which case the delays at the ingress/egress LSPs were low compared to when the signals had not been classified. Therefore the proposed scheme provided a means to improve the QoS in path restoration in MPLS using available network resources. Prioritizing the packets in the data plane has revealed that the amount of traffic transmitted using a medium and low priority Label Switch Paths (LSPs) does not have any impact on the explicit rate of the high priority LSP in which case the problem of a knock-on effect is eliminated.

Interoperability for eLearning Service Management and Provision

Learning Objects offer flexibility and adaptability for users to request personalised information for learning. There are standards to guide the development of learning objects. However, individual developers may customise these standards for serving different purposes when defining, describing, managing and providing learning objects, which are normally stored in heterogeneous repositories. Barriers to interoperability hinder sharing of learning services and subsequently affect quality of instructional design as learners expect to be able to receive their personalised learning content. All these impose difficulties to the users in getting the right information from the right sources. This paper investigates the interoperability issues in eLearning services management and provision and presents an approach to resolve interoperability at three levels.

Consumer willingness to pay for in-flight service and comfort levels: A choice experiment

In the competitive aviation market as a result of the emergence of low cost carriers, charter airlines have had to reconsider their approach to service provision. Specifically, the reduction in service and comfort levels offered by the low cost airlines provides charter carriers with an opportunity to differentiate their product based on the quality of the offering. To consider this strategic option we employ an on-line choice experiment to examine consumer choices with respect to the bundle of services on offer when deciding to purchase a flight, With these data we use the Bayesian methods to estimate a mixed logit specification. Our results reveal that in principle passengers are willing to pay a relatively large amount for enhanced service quality. (C) 2008 Elsevier Ltd. All rights reserved.

The graduate teacher programme in England: mentor training, quality assurance and the findings of inspection

In its recent report on the Graduate Teacher Programme (GTP), an employment-based route to Qualified Teacher Status (QTS) in England, the Government's Office for Standards in Education found that, although almost all trainees meet the standards required to qualify, too often they do so at an adequate level, rather than achieving the high levels of which they should be capable. The underlying reason for this is the quality of mentoring provided in the schools. The inspectors concluded that schoolbased trainers are often not adequately prepared for their role in implementing wide-ranging training programmes for trainee teachers. Despite this generally bleak picture, Ofsted concluded that 'the minority of cases of good practice in the training programmes and of high quality teaching by trainees indicate that the GTP can be an effective alternative route for training teachers'™. This article considers the strengths and weaknesses of the Graduate Teacher Programme, introduced in January 1998, and also reports on a small-scale project, funded by the Teacher Training Agency (TTA), the key objective of which was to strengthen the existing partnerships by improving the quality of school-based tutor training and continuous professional development of staff.

In-service training needs in an African context: a study of headteacher and teacher perspectives in the Gucha District of Kenya

Improving the quality of teaching is an educational priority in Kenya, as in many developing countries. The present paper considers various aspects of in-service education, including views on the effectiveness of in-service, teacher and headteacher priorities in determining in-service needs and the constraints on providing in-service courses. These issues are examined though an empirical study of 30 secondary headteachers and 109 teachers in a district of Kenya. The results show a strong felt need for in-service provision together with a firm belief in the efficacy of in-service in raising pupil achievement. Headteachers had a stronger belief in the need for in-service for their teachers than did the teachers themselves. The priorities of both headteachers and teachers were dominated by the external pressures of the schools, in particular the pressures for curriculum innovation and examination success. The resource constraints on supporting attendance at in-service courses were the major problems facing headteachers. The results reflect the difficulties that responding to an externally driven in-service agenda creates in a context of scarce resources.

Modelling requirements of supplier selection for benchmarking service provision

Supplier selection has a great impact on supply chain management. The quality of supplier selection also affects profitability of organisations which work in the supply chain. As suppliers can provide variety of services and customers demand higher quality of service provision, the organisation is facing challenges for making the right choice of supplier for the right needs. The existing methods for supplier selection, such as data envelopment analysis (DEA) and analytical hierarchy process (AHP) can automatically perform selection of competitive suppliers and further decide winning supplier(s). However, these methods are not capable of determining the right selection criteria which should be derived from the business strategy. An ontology model described in this paper integrates the strengths of DEA and AHP with new mechanisms which ensure the right supplier to be selected by the right criteria for the right customer's needs.

Distributed multimedia quality: the user perspective

Distributed multimedia supports a symbiotic infotainment duality, i.e. the ability to transfer information to the user, yet also provide the user with a level of satisfaction. As multimedia is ultimately produced for the education and / or enjoyment of viewers, the user’s-perspective concerning the presentation quality is surely of equal importance as objective Quality of Service (QoS) technical parameters, to defining distributed multimedia quality. In order to extensively measure the user-perspective of multimedia video quality, we introduce an extended model of distributed multimedia quality that segregates quality into three discrete levels: the network-level, the media-level and content-level, using two distinct quality perspectives: the user-perspective and the technical-perspective. Since experimental questionnaires do not provide continuous monitoring of user attention, eye tracking was used in our study in order to provide a better understanding of the role that the human element plays in the reception, analysis and synthesis of multimedia data. Results showed that video content adaptation, results in disparity in user video eye-paths when: i) no single / obvious point of focus exists; or ii) when the point of attention changes dramatically. Accordingly, appropriate technical- and user-perspective parameter adaptation is implemented, for all quality abstractions of our model, i.e. network-level (via simulated delay and jitter), media-level (via a technical- and user-perspective manipulated region-of-interest attentive display) and content-level (via display-type and video clip-type). Our work has shown that user perception of distributed multimedia quality cannot be achieved by means of purely technical-perspective QoS parameter adaptation.