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Clinical teams need more power in hospitals

Louise Prime

Thursday, 26 January 2012

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Hospital boards must be willing to give more power and control to clinical teams in order to realise the benefits of service-line management, The King’s Fund said today. Its latest report warns of inconsistent implementation of SLM, with huge variation between and even within trusts.

The health charity said that the current financial climate should act as a greater incentive for trusts to devolve control to specialist clinical areas, managed as distinct operational units, because SLM should improve quality and productivity as clinical leaders gain a greater understanding of services’ costs and performance. But in its report, Service-line management: Can it improve quality and efficiency?, it warns that some trusts are instead centralising control to cope with tighter budgets.

The King’s Fund researchers interviewed seven trusts’ board members, clinicians and finance staff about how SLM was being applied in their trust to bring about improvements in quality and efficiency.

They reported “significant variation” in different trusts’ application of SLM – although in some trusts it was seen to be driving service change, in others it was having little effect. There were even significant discrepancies between different service lines within the same trust, which was put down largely to differences in clinical leadership.

The report’s authors found that skilful implementation was essential to realising the potential benefits of SLM. They recommend:

  • Ensuring that staff at all levels ‘buy in’ to SLM, from board level downwards; clinical leads and executives must work together to improve confidence in decisions made
  • Making effective use of data – clinicians should identify useful data sources, all staff should understand the importance of continually improving data quality
  • Conducting rolling training programmes and working to maintain continuity when personnel change, so that momentum is not lost
  • Managing expectation – avoiding trying to “sell” SLM to clinicians as a simplistic means of retaining and reinvesting their own service-line surpluses
  • Adapting SLM and related methods to work across organisational boundaries, to support integrated care.

Lead author Catherine Foot, senior fellow at The King’s Fund, said: “It is clear that hospitals need to resist any temptation to row back from progress made in service-line management. Quite the contrary, increasing pressure for efficiency savings should drive hospital boards forward as SLM offers a means by which to gain a clear picture of a hospital’s activity and performance. This, in turn, allows informed and effective choices and decisions to be made.

“The majority of those interviewed for the research recognise the value of SLM and SLR to the management of the trust. However, a balance needs to be struck between realising the benefits from implementing these approaches and understanding they are only part of a wider solution to improve quality and efficiency. Trusts must be careful not to oversimplify or oversell these approaches and must continue to look beyond their walls towards whole system efficiency.”

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