We evaluate a theory of the effects of publishing performance information on citizens' collective voice to local providers about public service performance and the perceptions and attitudes that influence their voice. Field experiments show that information about low absolute and relative performance of local government household waste recycling services lowers citizens' perceptions of performance, and information about high absolute and relative performance raises perceived performance. Relative information makes citizens judge local providers as being more responsible for outcomes in the case of high performance, suggesting that systems for comparative performance reporting increase local accountability for outcomes. Negativity bias is evident, with information about low absolute performance reducing citizens' satisfaction but information about high performance not raising satisfaction. Information about low performance did not trigger collective voice protest behaviour as hypothesized, suggesting that providers who need citizens' collective voice the most do not get it.
BackgroundDelirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes.MethodsWe conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions.ResultsThe point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4–6 (frail) (OR 4.80, CI 2.63–8.74), 7–9 (very frail) (OR 9.33, CI 4.79–18.17), compared to 1–3 (fit). However, higher CFS was associated with reduced delirium recognition (7–9 compared to 1–3; OR 0.16, CI 0.04–0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75–5.07) and increased mortality (OR 2.43, CI 1.44–4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67–11.21).ConclusionsDelirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.
In recent years welfare services in Western Europe have been criticized for poor coordination. In response, 'seamlessness' has emerged as a vision for public administration with 'one-stop shops' viewed as means to reach this. This article conceptualizes the one-stop shop and presents a three country case study to examine its drivers and its adaptation. In all countries the reforms meant mergers driven by hopes for a single entrance to services as well as proximity to citizens. However, the analysis of task portfolios, participant structure, instruments and autonomy reveal important variations in the adaptations. The specific configurations of one-stop shops that emerged were partially a product of compromises and negotiations influenced by the political and performance priorities of central government. The classical trade-off between specialization and coordination persists, but by offering users ICT-based services one can to some extent maintain specialization behind the frontline and still provide services that are coordinated from a user perspective.
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