Showing papers in "Journal of Management in Medicine in 1990"

Cost‐Benefit Appraisal of Screening for Congenital Dislocation of the Hip

Abstract: Vibration arthrometry is a new non‐invasive technique which detects, records and analyses vibrations elicited during clinical examination of human joints. In congenital dislocation of the hip, the computer‐based method has been developed to achieve a more objective and earlier diagnosis than is otherwise available. This is a condition of 0.2 per cent incidence with which a child may be born or which can develop shortly after birth. If a diagnosis is achieved soon after birth, the treatment is simple, cheap and effective. However, if the disease is not diagnosed until the child is walking, treatment is complicated and expensive and the child will need lengthy hospitalisation with a poor prognosis. An evaluation was made of three options: existing screening system, higher level screening and use of the Belfast Hip Screener.

Management for Consultants

Abstract: A survey of National Health Service hospital consultants in the North Western Region of the UK showed the management activities that they undertook and what management training they thought would be useful. The results will help in planning the scope and content of management training for consultants.

Use of Variable Costs in Laboratory Management

Abstract: The use and limitations of variable costs in predicting the financial effects of changing workloads in clinical chemistry are illustrated and discussed. The study identified the 10 tests with the highest annual variable expenditure in clinical chemistry laboratories of a district general hos‐pital and a teaching hospital. Six tests were common to both laboratories. The differences were due to the demands of specialised depart‐ments on the laboratory in the teaching hospital. In the laboratories studied, a very small group of commonly requested inexpensive tests (blood gases, plasma glucose, creatinine, urea, sodium and potassium) accounted for a large proportion (36–54 per cent) of the variable expenditure. Establishing glucose, the test with the highest variable expenditure, as a discretionary test in the district general hospital decreased the total number of tests by 6.9 per cent but revenue expenditure fell by only 1 per cent. However, efforts to save money by reducing workload would be most productive if directed at tests with a high variable expenditure.

The Introduction of Capital Charges in the NHS

Abstract: The first part of this paper outlines the reasons for introducing capital charges in the National Health Service (the NHS) in England and the aims and objectives of the scheme The second part of the paper outlines how capital charges will operate and addresses some specific common issues which have been raised This section also refers to the methodology for developing the scheme and disseminating information on its implementation The third section of the paper examines the current and future implications of capital charges for the NHS

Management of the NHS Estate

Abstract: The National Health Service estate in England comprises about 50,000 acres of (mainly freehold) land on which stand about 2,000 hospitals and numerous other buildings. The value of the estate for existing use purposes has been estimated at £18bn. The annual running costs for the estate, for heating, light‐ing, maintenance, cleaning etc, amount to more than £1.5bn or about £50 for every square metre of built space. How well is this substan‐tial asset used, and what contribution can improved management of the NHS estate make to the business of health care? By more efficient use of the estate, significant sums of both revenue and capital can be released. More effective use of the estate can improve the quality of care offered to patients. More creative manipulation of the estate can generate income to support health care development.

Providing Excellent Patient Care with Resource Management

Abstract: A broad consensus seems to have emerged over the last five to ten years about the processes that characterise organisations that have performed well in the rapidly changing 1980s. These ‘excellent’ organisations have much to teach the British National Healtli Service. This paper considers how the Service can learn from them and adapt the lessons to its own situation. It will suggest that resource management could help to move the culture of the Health Service in the right direction, but that unfortunately it could also become an arid bureaucratic exercise in data collection. To encourage managers and professionals to use resource management to develop a culture of organisational excellence, it includes some questions that they could ask themselves as they consider its implementation. Favourable answers to these questions will give cause for optimism that resource management will be used to help the Service to provide more excellent patient care.

Use of IT to Improve Care and Save Resources: Why Present Proposals are Worrying, and Why the UK is Losing Ground

Abstract: Improvements in the quality of care are com‐patible with resource saving — but to achieve these desirable aims, doctors' performance must change. More attention should be paid to this aspect of health care management. However, interest is far greater overseas than in the UK at regional or national level. The current UK lack of interest (at Government level) in the potential of information technology for clinical decision‐support is already prevent‐ing patient, physician and the public purse front benefiting from a concept originally promoted in the UK but now more widely adopted abroad. Unless some sensible means can be devised for coordinating clinical decision support systems with audit, resource management initiatives and HISS — and ensuring some structure which will offer both clinicians and managers some practical benefit — the present vast expenditure on IT in the National Health Service may merely repeat (at a hundred times the cost) the unfortunate 1960s experiments with computers and public money.

Medical Negligence 2

Abstract: The second paper in this series looks at how damages are awarded in medical negligence cases and suggests reasons why they have increased over recent years. It then goes on to assess whether the UK is facing, or is about to face, an American‐style ‘malpractice crisis’. It is well known that the numbers of claims and the size of the awards of damages in the USA have led to doctors either paying astronomical sums in insurance premiums or failing to insure at all, rather risking bankruptcy in the event of litigation. The conclusion is, from the available evidence cited, that such a crisis has not occurred in Great Britain and will not occur, at least in the foreseeable future. Part 3 of the series follows on p. 282.

ECHSS: 10 Years On

Abstract: The European Collaborative Health Services Studies (ECHSS) form a programme of related projects involving collaboration between research workers and health care staff in different parts of Europe. One hospital was selected from each country involved for detailed study. The programme started in 1977 with an analysis and comparison of the data routinely available from local statistical sources on the supply of resources and levels of activity. Management ratios based on the ‘triangle’ of staff, beds and population were developed, and very substantial variation was found. This urns followed by analyses of case mix and a cross‐sectional ‘census’ of all those occupying beds in the hospitals concerned. The second five‐year period of the pro‐gramme took three complimentary directions. Work on hospital care became more focused; and patients with selected ‘tracer conditions’ were studied progressively, looking in more detail at the process of health care for comparable groups of patients. At the same time the scop...