Scarcely is there a more unloved bunch than the humble NHS manager. The public narrative surrounding the NHS very much regards these unwanted pen pushers as starving those who do the real work of funds and resources that ultimately result in the various states of chaos that the NHS is usually thought to be in.
It’s an image that has largely fallen into caricature, but as a recent study reveals it could have quite significant implications. The study found that managers in healthcare seem to correspond with higher clinical performance.
The researchers gathered data from 160 different hospital trusts in England over a period from 2007 to 2012. This period was selected as the data contained within it was consistent, both in terms of the performance of those trusts and HR numbers. The ultimate aim was to try and understand whether the number of managers in each trust had any impact on the overall efficiency of the hospital, the experience of the patients and general clinical quality.
Measuring effectiveness
To measure efficiency, the researchers compared the ability of each trust to increase their clinical outputs relative to their various inputs. So, for instance, patient experience would be gauged by examining data from the NHS Adult Impatient Survey, whilst clinical quality would be gauged via hospital infection rates.
Via regression analysis, the team were then able to attempt to draw a connection between the number of managers in a trust and the outcomes achieved by that trust.
When the data was analyzed, it revealed that a relatively small increase in the number of managers correlated with a 1% in crease in patient satisfaction, a 5% increase in hospital efficiency, and a 15% reduction in infection rates. These are gains that the authors estimate would cost approximately £500 million to achieve.
Now, there are obvious questions about correlation and causation, but the researchers believe that whilst it’s impossible to ascertain causation with certainty, it is nonetheless highly likely that a link exists between the number of managers and clinical effectiveness.
Under managed
The claim that the NHS is not so much over-managed as under-managed was reiterated in work conducted by the King’s Fund in 2017. Not only are there fewer managers in the NHS than in other health systems around the world, but the managers that are there are typically underpaid relative to managers in other sectors.
For instance, their data suggests that just 3.7% of the overall NHS workforce are managers, although the researchers admit that this doesn’t include clinical managers. Even using data from the Office for National Statistics, which reveals that managers make up 4.8% of the total NHS workforce, this still falls considerably below the 15.4% of the total UK workforce that operate in a managerial capacity. This level of staffing represents approximately 1-2% of the budget of the trust.
Whilst the number of NHS managers has risen by 37% between 1997 and 2010, this also coincides with a period in which health spending has doubled in real terms, so it’s perhaps fair to say that the NHS is still lagging behind in terms of the right number and quality of managers.
This matters, as a recent study by Stanford highlighted the value great managers can bring to an organization. The researchers examined around 11,000 companies from around the world over a number of years to try and ascertain what kind of management was being practiced.
When the analysis was complete, there appeared to be a strong correlation between the management scores and the productivity of a country. Interestingly however, this variation was not confined to international metrics, with considerable variance within countries too.
For instance, within the United States there was a significant difference in the managerial abilities of the most productive firms versus laggards. This materialized in a 15% boost to productivity for firms in the top 25% of managerial capability over those firms in the bottom 25%.
When this was examined across the world, the researchers believe that the quality of management was accounting for around 30% of the variance in productivity. What’s more, good management also appeared to correlate with higher skill levels for workers at those companies, which as the NHS is currently undergoing a review of the skills required to function effectively in the future is surely of great importance.
The Topol Review has looked in some detail at the skills required among the workforce, but it focuses almost exclusively on the skills of clinicians rather than those of managers, which given the review revolves around the need to integrate various new technologies into the NHS seems a major oversight given the key role they play in such transformation efforts.
Not only are there clearly not enough managers in the NHS, but they lack the technical skills of their peers in other sectors. The recent Data Literacy Index found that managers in healthcare were bottom of the pile in terms of data literacy, suggesting not only that the NHS would be well served by overcoming the stigma attached to investing in good management, but actively striving to do so.
