The impact of management on hospital performance

Miqdad Asaria,Alistair Mcguire,Andrew Street

doi:10.1111/1475-5890.12293

Miqdad Asaria, Alistair Mcguire + Show 1 more

Open Access

https://doi.org/10.1111/1475-5890.12293

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Journal: Fiscal studies	Publication Date: Jan 13, 2022
Citations: 3	License type: CC BY 4.0

Affiliation: Health Foundation

Abstract

AbstractThere is a prevailing popular belief that expenditure on management by health‐care providers is wasteful, diverts resources from patient care, and distracts medical and nursing staff from getting on with their jobs. There is little existing evidence to support either this narrative or counter‐claims. We explore the relationship between management and public sector hospital performance using a fixed effects empirical econometric specification on a panel data set consisting of all 129 non‐specialist acute National Health Service (NHS) hospitals in England for the financial years 2012/13 to 2018/19. Measures of managerial input and quality of management practice are constructed from NHS Electronic Staff Records and NHS Staff Survey data. Hospital accounts and Hospital Episode Statistics data are used to construct five measures of financial performance and of timely and high‐quality care. We find no evidence of association either between quantity of management and management quality or directly between quantity of management and any of our measures of hospital performance. However, there is some evidence that higher‐quality management is associated with better performance. NHS managers have limited discretion in performing their managerial functions, being tightly circumscribed by official guidance, targets, and other factors outside their control. Given these constraints, our findings are unsurprising.

Highlights

We find no evidence of a significant relationship between the quantity of management, whether measured as M1, M3 or M4, on management quality
There are no significant associations between any of the measures of managerial input and net financial position (Table 3), the proportion of elective patients who are treated within 18 weeks of being referred (Table 4), the proportion of A&E patients seen within 4 hours (Table 5) and the Summary hospital-level mortality indicator (SHMI) (Table 7)
Our suggested mechanism linking the quantity of management input to hospital performance set out in Figure 1 posited that, if a hospital can increase the quantity of management input, it should be in a better position to provide higher-quality management of staff, finances and patients and, produce better outcomes for the hospital

Summary

INTRODUCTION

It may be that NHS management is largely confined to these administrative roles, ensuring regulatory standards and requirements are met rather than inherently improving performance In this context, the relationship between the degree of managerial input and performance is likely to be tenuous at best, if evident at all. Management input has been conceived either as a distinct staff group in the hospital production function, as in Street et al (1999) and Soderlund (1999), or as a way to influence total factor productivity, as in Bloom et al (2016) Far, these approaches have found very little association between the degree of management input and hospital output. We conclude with a discussion and interpretation of our findings

SUGGESTED MECHANISM

Quantifying managerial input

Outcome measures

Controls

Does the quantity of managerial input affect management quality?

Does managerial input affect hospital outcomes?

DISCUSSION