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PubMed2004

Using performance indicators to improve performance.

The recent introduction of performance assessment within the UK NHS, incorporating numerous performance indicators (PIs) and league tables, has led to health care organisations facing large numbers of targets and a star rating system with associated rewards and penalties. However, there is considerable evidence that using PIs for judgement rather than learning provides perverse incentives and can prove counterproductive. Drawing on earlier PI systems which, supplemented by expert systems, were designed to promote learning and exploration particularly by encouraging analysis of interactions between different indicators, a series of 'mini case studies' is presented. These reveal interesting relationships and suggest explanations for variations in performance, areas worth exploring further and possible approaches to improving performance -- approaches not apparent from individual indicators and league tables. It is concluded that presentation of PIs in a format that encourages exploration and analysis could greatly enhance the potential of the current PIs to improve NHS performance.

Arthroplasty, Replacement, Hip↗

PubMed1989

Hearing-impaired students' performance on tests of visual processing: relationships with reading performance.

Performance of hearing-impaired students on selected tests of visual processing and the relationship between performance on those measures and on a test of reading comprehension were investigated. Seventy-seven subjects, all 7- and 8-year-olds, were tested using the MVPT, ITPA Sequential Memory Subtest, VADS, Jordan, VMI, Slingerland, and SAT-HI. Scores of the hearing-impaired subjects failed to match those of the hearing norm sample of the VADS test but no systematic differences were found on the other tests of visual processing. Performance IQ was strongly associated with both visual processing and reading scores. Significant portions of the variance in reading scores were explained by IQ and performance on tests of memory for visual stimuli. Visual tests without a memory component failed to explain significant portions of the variance in reading performance.

Achievement↗

PubMed1998

Benefits of providing cognitive performance strategies to novice performers learning a complex motor skill.

Verbal reports were collected from experienced performers during acquisition trials of a novel throwing task and summarized as cognitive performance strategies. These strategies were incorporated in the practice regimen of 8 novices with no sport experience who learned the same task. A control group of 8 novices practiced the task without the experts' cognitive performance strategies. The performance of the novices who used the strategies was similar to that of the experts and significantly better than the performance of the control novices.

Achievement↗

PubMed2002

[The expertise of an actor: script reading, performance planning, and actual performance].

In this study, we examined the expertise of actors, for which few studies have so far been conducted. Participants for the study, all male, were ten novice actors with less than one year experience, ten intermediate actors with experience of one to five years, and ten junior expert actors with more than five years of acting. The process of acting in a play was divided into three phases; script reading, performance planning, and actual performance. We asked some questions of participants in each phases, and analyzed video recording of their actual performance. Results suggested that novice actors had some difficulties in understanding the 'written' in the script. It was also suggested that in planning performance, the longer experience the actor had, the more things he could take into account, and the longer he spent for the preparation. Therefore, performance of junior expert actors was more diversified. Our findings also indicated that junior expert actors were more adept at expressing what they wanted to without being consciously aware of what they had actually to do.

Adult↗

PubMed2004

Cytologic features of squamous cell carcinoma in ThinPrep slides: evaluation of cases that performed poorly versus those that performed well in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.

CONTEXT: Although the cytologic features of squamous cell carcinoma in ThinPrep specimens are well known, whether these features are different in cases that are easily identified than in cases that are more difficult to identify is not known. OBJECTIVE: To determine the cytologic features of squamous cell carcinoma in ThinPrep specimens that are easy to identify versus those that are difficult. DESIGN: The cytologic features of 6 cases of squamous cell carcinoma that performed poorly in the College of American Pathologists Interlaboratory Comparison Program were compared with 14 cases that performed extremely well. RESULTS: After evaluation of multiple criteria, 7 different cytologic features were analyzed based on review by a consensus panel blinded to the performance of the cases. The feature that was most strongly associated with cases that performed poorly was the presence of Trichomonas vaginalis (5/6 [83%] vs 0/14; P <.001). The presence of marked nuclear pleomorphism was more common in cases that performed well (4/14 [28%] vs 0/6; P =.27), but was not significant. The number of tumor cells, the number of normal cells, and the presence of keratinization, pleomorphism, nucleoli, and diathesis were not significant. The most common misdiagnosis after Trichomonas vaginalis was reparative change. CONCLUSIONS: The presence of Trichomonas is characteristic of cases of squamous cell carcinoma in ThinPrep slides that are often misdiagnosed in this program. While Trichomonas is identified by participants in some of these cases, a significant percentage of participants interpreted the findings as reparative, without identifying the organism. These results emphasize the importance of distracting factors, whether identified or not, in evaluating gynecologic cytology.

Carcinoma, Squamous Cell↗

PubMed2005

Cytologic features of squamous cell carcinoma in conventional smears: comparison of cases that performed poorly with those that performed well in the College of American Pathologists Interlaboratory Comparison Program in cervicovaginal cytology.

CONTEXT: Characteristic cytologic features have been identified that distinguish cases that are always identified from those that are sometimes missed in the College of American Pathologists Gynecologic Cytology Program for a variety of different lesions and preparations. OBJECTIVE: To compare the cytologic features of cases of squamous cell carcinoma in conventional smears that perform poorly and well. DESIGN: The cytologic features of 8 conventional smear cases of squamous cell carcinoma that performed poorly in the College of American Pathologists Interlaboratory Comparison Program were compared with 17 cases that performed extremely well. RESULTS: A total of 2387 individual interpretations were recorded. Of the 86 incorrect responses, 6.2% were for repair, and 0.8% were for Trichomonas. Cases that performed well were significantly more likely to have greater than 1000 dysplastic cells (16/17 vs 4/8, P = .02) and be keratinized (13/17 vs 1/8, P = .007). Obscuring inflammation and cell size were not significant. CONCLUSION: Conventional smears with a diagnosis of squamous cell carcinoma that were always identified were significantly more likely to have greater than 1000 cells and be keratinized than cases that performed poorly.

Carcinoma, Squamous Cell↗

PubMed2006

Cytologic features of adenocarcinoma, not otherwise specified, in conventional smears: comparison of cases that performed poorly with those that performed well in the College of American Pathologists Interlaboratory Comparison Program in cervicovaginal cytology.

CONTEXT: Characteristic cytologic features have been identified that distinguish cases that are consistently identified from those that are sometimes missed in the College of American Pathologists Gynecologic Cytology Program for a variety of different lesions and preparations. OBJECTIVES: To compare the cytologic features of cases of adenocarcinoma, not otherwise specified (NOS), in conventional smears that perform poorly and well. DESIGN: The cytologic features of 21 conventional smear cases of adenocarcinoma, NOS, that performed poorly in the College of American Pathologists Interlaboratory Comparison Program were compared with 17 cases that performed extremely well. RESULTS: Cases that performed well were significantly more likely to have greater than 1000 abnormal cells (P = .006), greater than 100 large abnormal cells (P = .006), large nuclei (P < .001), marked nuclear atypia (P = .02), and hyperchromasia (P = .02). Repair-like features were rare in both groups and were not significant (P = .71). CONCLUSION: Conventional smears with a diagnosis of adenocarcinoma that were consistently identified were significantly more likely to have more abnormal cells, larger abnormal cells, larger nuclei, marked atypia, and hyperchromasia than cases that performed poorly.

Adenocarcinoma↗

PubMed1997

Performance of 2- and 3-year-old children and prediction of 4-year from 1-year performance.

OBJECTIVE: To examine whether children perform better when they receive cochlear implants when they are 2 to 4 years of age than when they are older, and to determine whether 4-year performance can be predicted from 1-year results. METHOD: Children in two age groups (2 to 4, 4 to 9 years) were tested for performance, and the age groups were compared. Children were also tested 1 and 4 years after implantation. RESULTS: The results suggest that the "implanted young" group scored higher than the "implanted old" group after 36 months, and that 1-year performance is helpful in predicting 4-year performance. CONCLUSION: It may be desirable for children to undergo implantation when they are under 2 years of age, provided that appropriate selection criteria can be determined.

Child↗

PubMed2005

The impact of job complexity and performance measurement on the temporal consistency, stability, and test-retest reliability of employee job performance ratings.

Although research has shown that individual job performance changes over time, the extent of such changes is unknown. In this article, the authors define and distinguish between the concepts of temporal consistency, stability, and test-retest reliability when considering individual job performance ratings over time. Furthermore, the authors examine measurement type (i.e., subjective and objective measures) and job complexity in relation to temporal consistency, stability, and test-retest reliability. On the basis of meta-analytic results, the authors found that the test-retest reliability of these ratings ranged from .83 for subjective measures in low-complexity jobs to .50 for objective measures in high-complexity jobs. The stability of these ratings over a 1-year time lag ranged from .85 to .67. The analyses also reveal that correlations between performance measures decreased as the time interval between performance measurements increased, but the estimates approached values greater than zero.

Employee Performance Appraisal↗

PubMed1991

Continuous performance tests in schizophrenic patients: stimulus and medication effects on performance.

Medicated (n = 17) and unmedicated (n = 17) schizophrenic patients were compared to a normal control group (n = 19) on their performance on auditory and visual versions of the Continuous Performance Test (CPT). Within each stimulus modality, performance was examined on lexical and nonlexical target stimuli. Neuromotor competence was assessed on the basis of motor speed and proficiency. Normal subjects made fewer errors of all types than schizophrenic patients. Unmedicated patients made significantly more errors on nonlexical stimuli than medicated patients, with medication status found not to be associated with stimulus modality effects. Motor proficiency was associated with CPT performance in the medicated patients, but not the unmedicated ones, although this difference in correlations did not account for the group differences between these patients. The authors discuss the implications of these data for the type of cognitive and attentional functions that are affected by medication in schizophrenia.

Adult↗

PubMed1993

The self-efficacy-performance link in maximum strength performance.

To examine whether manipulating self-efficacy affects strength performance on a bench press, and to see if these situation-specific changes would affect levels of physical self-efficacy, 24 undergraduates untrained in weightlifting were randomly assigned to three groups: 'light', who lifted less weight than they believed; 'heavy', who lifted more weight than they believed; and control, for whom there was no manipulation. Self-efficacy measures were taken before and after the manipulation. Physical self-efficacy was measured using the Physical Self-Efficacy Scale (PSE). 'Light' subjects lifted significantly greater increases in weight than the other subjects. 'Heavy' subjects significantly decreased self-efficacy following the manipulation. Initial self-efficacy was found to be a significant predictor of baseline maximum, while manipulated self-efficacy was significant for performance change. The PSE scores did not change pre- to post-study. The results suggest that self-efficacy is a situation-specific construct which can be manipulated, and which relates to both past performance experience and future performance.

Adult↗

PubMed2001

Effects of d-amphetamine on the performance of rats in an animal analogue of the A-X continuous performance test.

Schizophrenia patients subjected to the A-X Continuous Performance Test (A-X CPT) show cognitive deficits that are thought to reflect impaired representation and maintenance of context information. An issue deserving attention is to what extent the acute amphetamine model of schizophrenia also models these cognitive deficits. The present experiment examined the effect of acute d-amphetamine (AMP) on the performance of rats in an animal analogue of the A-X CPT. Subjects first learned to solve an A --> X+, B --> X-, A --> Y- discrimination task, with A and B representing visual features; X and Y designating auditory target stimuli; --> signifying a serial presentation; and + and - referring to food reinforcement and non-reinforcement, respectively. Frequency of food-magazine visits was the dependent measure. After mastering the discrimination, rats received test trials under either saline or 0.5 mg/kg AMP (s.c.). At test, the interval between feature and target presentation was varied; reinforcement contingencies were maintained. AMP significantly impaired performance on the A --> X+/B --> X- discrimination by increasing the response level on B --> X- trials. AMP did not significantly affect performance on the A --> X+/A --> Y- discrimination. However, AMP also increased magazine responding in the absence of the presentation of features and targets. A parsimonious conclusion based on these preliminary results is that acute AMP does not affect processing of context information provided by the visual features in this procedure. It rather has a more non-specific response-enhancing effect, especially with respect to stimuli associated with the delivery of food.

Animals↗

PubMed1980

Appraising the performance of performance appraisal.

This article provides a critical examination of formal performance appraisal systems in organizations. It argues that the role, effectiveness, and validity of appraisal data are limited by a number of organizational factors: the purposes of the appraisal (both avowed and covert), the characteristics of the tasks for which the appraisal is performed, and the location in the structure of the organization of both appraisers and appraisees. The authors conclude that data from formal performance appraisal systems should never be utilized alone and uncritically, without full consideration of the context in which the appraisal is being performed and used.

Employee Performance Appraisal↗

PubMed1989

Performance appraisal and pay-for-performance start at the top.

In summary, while performance appraisal has always been present in health care, it is taking on a new dimension. Evaluative criteria based on personality traits are being replaced by quantifiable, specific, job-related factors. Performance appraisal in many organizations is no longer an abstract, generalized concept, but is predicated on specific, predetermined corporate or institutional goals for which the CEO is held directly responsible and accountable. In other words, the activities at the lowest level in the organization have direct impact on the highest levels. While pay-for-performance is still more common at the management level, an increasing number of institutions are applying the concept across the board. It is imperative that first-line supervisors understand how their own performance is appraised and their compensation determined before trying to explain a new concept to their subordinates. Even more important, the first- and second-line supervisors should have direct input into the development of new pay programs for their subordinates.

Employee Performance Appraisal↗

PubMed2001

A disruptive effect of bizarreness on memory for relational and contextual details of self-performed and other-performed acts.

We examined recognition memory for relational and contextual details of bizarre and common acts that were either self-performed or performed by another. The results support previous findings that bizarreness disrupts memory for relational details and provide evidence that bizarreness also disrupts memory of the general context in which objects of actions occurred. The disruptive effects of bizarreness were found in memory for both self-performed and other-performed acts. Although parts of bizarre events are remembered well, information about the context in which the remembered part occurs and relationships among remembered parts are not remembered well.

Adult↗

PubMed1999

Comparison of laparoscopic performance in vivo with performance measured in a laparoscopic simulator.

BACKGROUND: Laparoscopic skill was measured objectively through a series of seven tasks in an inanimate laparoscopic simulator. Seven analogous skills were tested in an in vivo porcine model. These skills included transferring, cutting, clipping, placement of a ligating loop, mesh placement, and suturing with an intracorporeal and extracorporeal knot. Scoring of each task rewarded precision and speed. METHODS: Twelve PGY3 residents were given a baseline evaluation in the simulator and in the animal model. They were then randomized to either five practice sessions in the simulator (group A) or no practice (group B). Each group was retested in the simulator and in the animal (final test). Scores in vivo were compared by t-test for baseline versus final evaluation for each group. Linear regression analysis was used to correlate in vivo and in vitro scores for each task and for the total score (sum of all scores). RESULTS: Group A showed significant improvement in performance in vivo for cutting, clipping, mesh placement, and suturing with an intracorporeal and extracorporeal knot, as well as in the total score (p < 0.05). Group B showed significant improvement in suturing with an intracorporeal and extracorporeal knot, and in the total score. The magnitude of improvement from baseline to final evaluation was significantly greater for group A (p < 0.05). There was significant correlation between in vitro and in vivo total scores and the score for each task (p < 0.05) except for placement of the ligating loop and mesh. CONCLUSIONS: Performance in an in vitro laparoscopic simulator correlated significantly with performance in an in vivo animal model. Practice in the simulator resulted in improved performance in vivo.

Animals↗

PubMed1989

Work performance by persons with multiple sclerosis: conditions that impede or enable the performance of work.

This study queried 508 persons diagnosed with multiple sclerosis (MS) regarding what conditions made performing their work or tasks 'difficult' and 'easier'. The subjects represented four groups: employed outside the home, homemakers, unemployed, and retired. Their written responses were content analysed. Conditions reported to impede the performance of work and tasks were related to three categories: physical restrictions, person-environment interaction, and MS-related symptoms. Conditions reported to enhance the performance of work and tasks were related to five categories: assistive devices, human support, personal attributes, health promotion behaviors, and person-environment adjustment. Study findings provide useful information for families, health service providers and employers of persons with MS in assisting them enhance their ability to perform work or tasks.

Activities of Daily Living↗

PubMed2005

Performance limits of monolithic and packed capillary columns in high-performance liquid chromatography and capillary electrochromatography.

A method is proposed for the comprehensive characterization and comparison of columns in the high-performance liquid chromatographic (HPLC) and capillary electrochromatographic (CEC) modes. Using this approach, column parameters such as the number of plates, the eddy-diffusion and mass-transfer contributions to peak broadening, the permeability, and the analysis time are incorporated in a single graph and a comparison in terms of efficiency and speed is obtained. The chromatographic performance of silica-based and polymer-based monolithic capillary columns is discussed and a comparison is made with the performance of packed columns. Also, the potential of ultra-high-pressure liquid chromatography is discussed in this context. In the HPLC mode, the best results were obtained with silica monoliths; in the CEC mode, the low-density methacrylate-ester-based monoliths showed the best performance.

Chromatography, High Pressure Liquid↗