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Clinically trained managers make for safer hospitals

NHS advised to draw more senior managers from nursing and medicine

OnMedica staff

Monday, 15 February 2010

Hospitals where senior management have clinical experience tend to score better in terms of patient outcomes and staff satisfaction according to a new study.

Academics from the Centre for Economic Performance at the London School of Economics led by professor John Van Reenan used a modified version of the methodology used to measure management practices in manufacturing the retail sector. They questioned doctors and managers in orthopaedics and cardiology in 100 acute hospitals. And they used an evaluation system that defines and scores 18 different management practices from one (best practice) to five (worst practice).

While large variations in performance are a factor across hospitals as well as other sectors of the economy the study found that hospitals generally score badly on people management. But where hospitals scored better as people managers they also had better outcomes.

It found management appears to be better in hospitals where senior managers have some clinical training. "This makes sense as such managers are better able to understand, communicate with and challenge powerful senior doctors. Drawing more senior managers from clinical ranks, as done in the United States, would be a good policy move."

They found that hospitals with higher management scores have better clinical outcomes. "For example lower mortality rates from emergency heart attacks, shorter waiting times, better financial performance and higher staff satisfaction.

"One standard deviation improvement in management was associated with a fall in death rate from heart attacks from 17% to 16%. Such an improvement would result in 400 fewer deaths a year in our sample from this condition alone," the study found.

They also found that effective competition between hospitals stimulates better management and higher productivity.

"In healthcare competition is based on geography - hospitals tend to compete with other local hospitals. We find that hospitals with many other local hospitals nearby tend to have significantly better management practices.

"Using this experimental approach only strengthens our conclusion that competition has a large effect in improving managerial quality in hospitals."

Even in a regulated environment, where monitoring agencies and regulators decide how well a hospital is performing the number of hospitals will have an impact. In an area with many hospitals it’s easier to assess the performance of each hospital by comparing it with its neighbours.

"Finally a more competitive environment might provide a more attractive labour market for high-quality managers. With more hospitals nearby it is easier for managers to look for better job opportunities. But whatever the exact mechanism having more local rivals does appear to have advantages for management and patient care."

Another general indicator of hospital performance is the overall rating from the Healthcare Commission, (now superseded by the Care Quality Commission) which rises with better management practice. "Although we cannot be sure that these are causal effects, the strength of correlation is suggestive of important effects of management practices on hospital performance."

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