Journal of Management and Marketing in Healthcare 1(4)

Effective people management in an ever-changing NHS environment

Editorial
Contract management and monitoring in healthcare

The principles for commissioning in the national and independent healthcare systems are largely similar and much of BUPA’s 60 years’ experience in contracting and provider management of UK healthcare is applicable to the NHS as well. This paper discusses some of BUPA’s current practices in demand and supply analysis, contracting and provider management. The paper provides examples of BUPA’s ongoing work in quality monitoring and improvement, and describes how these are relevant for the NHS. Investment in commissioning competencies, tools and systems has paid off for BUPA, and there are great opportunities for continuously improving customer value in terms of cost, quality and service in both the public and private sectors.

Evolving patient safety strategies: A comprehensive solutions-based approach

The movement toward demonstrable quality and value in medical care is on a fast track because payers, weary of mediocre service, are tying payment to the reliability of excellent outcomes. The challenge for healthcare leaders is increasing as complexity and poor management causes variation in care with extraordinary medical error rates. Highly reliable work environments have specific characteristics. Leaders must embrace values of non-negotiable respect and appropriate accountability. Teamwork training is essential as is ongoing measurement of cultural indices. A linked strategy, structure and execution is necessary. This paper describes the steps to achieve a learning and reliable healthcare culture.

Exploring technological innovation in health systems: Is Canada measuring up?

The societal and economic benefits of technological innovations are indisputable. However, the race for knowledge and talent to develop and commercialise health innovations has never been so fierce. Countries traditionally seen as leaders in health innovation — countries such as the UK — are being challenged by newer players. This study examines how technological innovation is encouraged, and discouraged, in Canada and other selected Organisation for Economic Cooperation and Development (OECD) countries, including the UK, France and the USA. The research uses The Conference Board of Canada’s Innovation Framework as an analytical tool in benchmarking the performance of Canada and other OECD countries in several areas of health innovation, including the innovation environment, and the creation, diffusion, transformation and use of knowledge. The results of this study are discouraging for Canada as it scores poorly in many important areas of technological health innovation. Substantial efforts are needed, and needed now, to revitalise health innovation systems and to refuel the capacity to commercialise health innovations. Action in four key areas is recommended.

Implementation of a hospital-based wellness programme: Do cash incentives promote healthier behaviour?

In 2004, the Florida Hospital Zephyrhills developed an employee-based, volunteer programme known as the Lifestyle Incentives For Employees (LIFE) Plan to encourage weight management, exercise and cessation of tobacco use. The purpose of this study is to: (a) compare the health expenditure costs of 41 employees with continuous enrolment in the LIFE Plan and 32 employees who never enrolled in the LIFE Plan; and (b) describe the Wellsource Personal Wellness Profile data of the 620 LIFE Plan members since the inception of the programme, with emphasis on chronic medical conditions affecting number of sick days and hospital days. The data show a downward trend in the annual healthcare expenditures for LIFE Plan members. For the most commonly reported medical conditions from the profile data, individuals with hypertension, arthritis, back pain and joint pain have more sick days and more hospital days than individuals without these medical conditions. The LIFE Plan shows the possibility of reducing high health insurance costs using an employee-based health programme. By incorporating clear worksite health education messages to encourage behaviour changes that remedy chronic conditions, the longitudinal results are expected to contribute to greater cost reductions in the future.

Non-urgent use of the emergency department: A quantitative evaluation from a patient perspective

The objectives of this study are twofold: to investigate the reasons why patients considered as non-urgent by physicians visit the emergency department, and to explore the relationship between patients’ perceived urgency and the factors in the behavioural model of utilisation. This cross-sectional study develops a survey instrument to assess the predisposing, enabling and need factors affecting patients’ perceived urgency. In order to identify the independent variables associated with the perceptions of urgency, a multiple logistic regression model is used. According to the results, two-thirds of patients perceive their problem as urgent. Level of pain and duration of complaint are found to be significant factors affecting patients’ perceptions. For patients perceiving their problem as non-urgent, the most common reasons for visiting an emergency department include infections, dressings and the like. The findings support the general conclusion that the definition of urgency differs for patients and health professionals. The reasons why patients with non-urgent problems use emergency departments in Turkey include problems attached to primary healthcare facilities, crowded outpatient clinics, difficulty getting outpatient appointments and accessibility problems due to working hours.

Payment by Results as a lever for NHS reforms

Payment by Results (PbR), the English prospective payment system of paying healthcare providers, was introduced to respond to concerns that the previous system of financing was not providing sufficient incentives to NHS service providers to deliver efficiency and productivity. Initially targeted at acute, elective activity, the policy’s ambition included improved access to care, efficiency gains, transparent and fair financing, and facilitating the key reform of choice and plurality. PbR has, by and large, contributed to the implementation and gains derived from these reforms. Much of the emphasis has been on the technical mechanisms of PbR. Little attention has been given to the consequential behavioural responses, and potential perverse incentives that it can create. On balance, it can be seen to have been a helpful tool. This paper will give a clear sense of the strength and limitations of the policy. It will make clear the pragmatic amendments to policy that have been needed to move from a purist Prospective Payments Model to one that seeks to maintain the major policy drivers, but is workable within the NHS. It concludes that even with these changes, PbR can become a powerful lever for reforms in the delivery of healthcare.

Proactive recruitment in local government

New ways of partnership working, new organisational structures, and new role and skill demands are among the challenges facing organisations engaged in commissioning and/or delivering services to local communities. Within this context, local councils have the additional challenges of an ageing workforce, and recruitment and retention difficulties in key service areas and leadership roles. As the pool of appropriately qualified and experienced people shrinks, a competitive market for key professionals has emerged, creating retention problems throughout the UK. Radical changes beyond the scope of individual councils have been required to tackle these shortages and workforce and succession planning have become increasingly important as a result. Supported by national activities, collaboration rather than competition is now occurring to increase supply locally and regionally. Individual employers are also reviewing their existing workforce and creating new pathways to progression in line with new ways of working. Examples of national activities and case studies from social care, environmental health and planning are offered as illustrations of these proactive steps.

The assessment of doctors’ performance: Tools and techniques

There has been increasing organisational and research interest regarding the assessment of the performance of medical practitioners. Much of this progress has already been implemented in both the UK and internationally. This change is being driven both by statutory requirements and by the desire of the profession to improve practice and promote excellence. The process of developing an assessment system is well described. There are several steps including defining the content to be assessed, setting standards, defining the purpose of the assessment, identifying the tools to be used, implementation and making decisions with the results. Many methods of performance assessment have been suggested; some have been extensively evaluated and their psychometric properties are well known. For others, much less data are available. Some of the key steps in designing assessment systems will be described along with a more detailed discussion of selected assessment methods. The effective implementation of performance assessment continues to be a challenge for all those involved in the provision of quality healthcare.

The productive efficiency of blood banks: Using data envelopment and simple ratio analyses to measure the performance of health services

Simple ratio analysis (SRA) and data envelopment analysis (DEA) are widely used in benchmarking to identify organisations with best practice. This study tests the consistency of the two methods by investigating whether they could substitute for each other in performance measurement. To evaluate the relative precision of the two techniques, the paper studies comparative data from 31 second class blood banks in Greece for the year 2003. Optimality is investigated based on four performance outcomes: donor recruitment, blood sufficiency, wasted blood units and transfusion reactions. Comparison of SRA and DEA is employed in pair-wise efficiency scores. Results yield high statistical significance under assumptions of both constant returns to scale and variable returns to scale. The results confirm that the two measuring techniques are closely related and consistent.