Hospitals less likely to shut in marginal seats
Transcrição
Hospitals less likely to shut in marginal seats
Hospitals less likely to shut in marginal seats | Society | The Observer Page 1 of 2 Hospitals less likely to shut in marginal seats Closures take place in safe constituencies because there is less fear of a voter backlash Anushka Asthana and Denis Campbell The Observer, Sunday 14 February 2010 larger | smaller Hospitals located in safe parliamentary seats where political competition is weak are much more likely to be closed than those in marginal constituencies, new research reveals. The study, by academics at the London School of Economics, illustrates just how damaging shutting hospitals can be, with the authorities seemingly shying away from closures in politically sensitive areas. The report also reveals how much of a difference good management can make to the way in which hospitals operate. It finds that: ■ A slight improvement in the way in which a hospital is managed can result in up to 400 fewer deaths each year. ■ Hospitals are best managed when doctors and nurses are employed in senior management positions. ■ Those that perform best are in areas with a higher number of hospitals nearby, increasing competition. Professor John Van Reenen, director of the Centre for Economic Performance at the LSE and co-author of the report, said he wanted to find out why hospital performance varied so much around the country. The academic said the study, which looked at 100 English hospitals and will be published this week in the journal Centrepiece, found that patients taken to well-managed hospitals after a heart attack were significantly more likely to survive. He said it made sense that hospitals did well when people with clinical experience were in charge, because they could communicate in a language that "doctors and nurses understand". In terms of closures, he added: "We found that in marginal constituencies hospitals are much less likely to be closed down. So there are far more hospitals in politically marginal wards." The reason, he added, was because health was the top priority for most people. "It is what people care about. What people really want to know is whether they will be looked after if they become unwell, and whether their relatives will be cared for." He highlighted the case of Richard Taylor, a doctor whose campaign to keep Kidderminster hospital open resulted in him unseating a Labour minister in Wyre Forest in 2001. He then held on to the seat in 2005. Taylor said there was always a "political element" when NHS services were reconfigured and decisions were made around units closing down. But he argued the key issue was whether there were alternative medical services nearby. The MP refuted the notion that more competition improved hospital performance and said he was ardently against the market. "Since the instigation of the internal market in the NHS, and the purchaser-provider split and thus of competition, the numbers of management personnel have gone up sharply, sometimes by as much as tenfold." Dr John Lister of Health Emergency, which campaigns against private-sector http://www.guardian.co.uk/society/2010/feb/14/hospital-closures-marginal-seats-nhs/... 05/03/2010 Hospitals less likely to shut in marginal seats | Society | The Observer Page 2 of 2 involvement in the NHS, agreed, arguing that co-operation rather than competition led to better health outcomes. "Under competition a few strong hospitals do better than others, but how do you then raise the standards of the others?" David Furness, head of strategic development at the Social Market Foundation, said that the NHS was about far more than just hospitals and that protecting health services should be about "values not buildings". "We need fewer hospital beds. People are treated more rapidly than ever before," he said. "But fewer beds mean fewer hospitals. And politicians will not accept the inevitable political pain of hospital closures. With the crisis in public finances threatening the future of the health service, this fixation with protecting hospitals from closure might tip the NHS over the edge." guardian.co.uk © Guardian News and Media Limited 2010 http://www.guardian.co.uk/society/2010/feb/14/hospital-closures-marginal-seats-nhs/... 05/03/2010 Hospitals more likely to close in safe seats - Telegraph Page 1 of 2 W Hospitals more likely to close in safe seats Hospitals in safe parliamentary seats are much more likely to be closed than those in marginal constituencies where politicians fear a backlash from voters, a study has found. By Heidi Blake Published: 7:30AM GMT 15 Feb 2010 The report by academics at the London School of Economics (LSE) shows that there is a far higher concentration of hospitals in politically sensitive areas “where no one wants to be blamed for hospital closure” than in areas where the Government enjoys a comfortable majority. Patients receive significantly better care in areas with a greater number of hospitals, because competition drives medical staff to do a better job, the report said. Related Articles Norwich North by-election: Conservatives quietly confident despite low turn-out MPs' expenses: Jonathan Djanogly owns shares worth over £1m MPs expenses scandal won't be forgotten by voters Tories share the blame for MPs' current unpopularity Japan's political dynasties no longer appeal It also showed that private hospitals are better managed than those run by the NHS, and disclosed the devastating consequences that poor management can have for patients. Around 400 deaths could be prevented every year from heart attacks alone if hospitals made a tiny improvement in the way they were managed, the study from LSE’s Centre for Economic Performance (CEP) found. In one badly-run hospital, a manager admitted that able-bodied patients had been forced to help push the sicker patients around in their beds because of staff shortages. Professor John Van Reenen, director of the CEP and co-author of the report, said the findings showed how patients in safe parliamentary seats, where competition among hospitals is low, can suffer. “What we have found is that if you’re in a marginal seat you have a lot more hospitals, but if you’re in a safe seat your local hospitals are much more likely to close,” he said. “It’s hard for any Government to close down a hospital because the public will not like it, and because of that politicians are less likely to close down a hospital in an area that’s more politically contestable.” The reason for the disparity was that health was a top priority for most voters, Prof Van Reenen said. "It is what people care about. What people really want to know is whether they will be looked after if they become unwell, and whether their relatives will be cared for.” The study, which looked at 100 hospitals, disclosed that patients taken to well managed hospitals after a heart attack were significantly more likely to survive. http://www.telegraph.co.uk/health/healthnews/7237186/Hospitals-more-likely-to-clos... 05/03/2010 Hospitals more likely to close in safe seats - Telegraph Page 2 of 2 It found that management scores in NHS hospitals were generally lower than in the private sector, including in the manufacturing and retail industries as well as in private hospitals. Hospitals managed by executives with no clinical experience perform worse than those where doctors and nurses are promoted to senior management positions, according to the report, which will be published this week in the journal Centrepiece. “People management” was particularly bad in the NHS, the report said. In one institution, an NHS manager who was asked whether staff often ended up doing the wrong sort of work for their skill level said: “You mean like doctors doing nurses’ jobs and nurses doing porter jobs? Yeah, all the time. Last week, we had to get the healthier patients to push around the beds for the sicker patients.” Prof Van Reenen highlighted the case of Richard Taylor, a doctor whose campaign to keep Kidderminster hospital open resulted in him unseating a Labour minister in Wyre Forest in 2001, as evidence that local hospitals are highly charged politically. © Copyright of Telegraph Media Group Limited 2010 http://www.telegraph.co.uk/health/healthnews/7237186/Hospitals-more-likely-to-clos... 05/03/2010 BBC News Douglas Fraser’s Ledger Tuesday 16 February, 2010 Hospital pass While Conservatives are suggesting hospitals and other public services could be run by co-operatives, we've got new evidence of the difference a good management makes. The Centre for Economic Performance has just published research showing that hospital services tend to be better when managers have some clinical experience. They also found hospitals have better management where there are a larger number of competing hospitals nearby - though couldn't that be a factor of being in a larger population centre, with more patient throughput? However, really, truly amazing is the finding that hospitals in marginal constituencies are "much less likely to be closed" than those in safe seats. Who'd have thunk it? FT.com print article Page 1 of 1 UK POLITICS & POLICY Close Competition good for hospitals, study says By Nicholas Timmins, Public Policy Editor Published: February 18 2010 23:13 | Last updated: February 18 2010 23:13 Competition produces better managed hospitals which, in turn, produce better outcomes for patients, according to new research from the Centre for Economic Performance at the London School of Economics. With the role of choice and competition in the National Health Service still highly controversial – the British Medical Association is currently running a large campaign against the commercialisation of the NHS – the research provides “clear cut evidence that competition between hospitals produces benefits,” Carol Propper, one of the study’s authors, said. The study interviewed managers and clinicians at 100 big NHS hospitals, using a mildly adapted version of a standard measure of management performance that is widely used to assess private sector companies. It compared the quality of management with a small range of clinical outcomes – such as deaths from heart attacks and emergency surgery, or hospital-acquired infections – and the scores given to hospitals for quality of care and financial management by the NHS inspectorate, the Care Quality Commission. It then looked at how many local rivals the hospitals had. The conclusion, Professor Propper said, is that “better management produces better hospitals and competition between hospitals produces better management”. Hospitals “with higher management scores have better clinical outcomes, shorter waiting times, better financial performance and higher staff satisfaction,” the study concludes. Management was better where senior managers have some clinical training – a finding that reinforces repeated government attempts over recent decades to involve clinicians more in management. But it also concludes that “competition has a large effect in improving managerial quality in hospitals”. How it does so remains open to question, the study says. It may be that the market reforms in the NHS, with money attached to each treatment, mean “hospitals now have an incentive to provide better care to attract patients”. In areas with a relatively large number of competitors, it may be easier to assess performance by comparison with neighbours. Or it may be that a competitive environment provides an attractive market for good managers. “With more hospitals nearby, it is easier for managers to look out for better employment opportunities”. Copyright The Financial Times Limited 2010. Print a single copy of this article for personal use. Contact us if you wish to print more to distribute to others. "FT" and "Financial Times" are trademarks of the Financial Times. Privacy policy | Terms © Copyright The Financial Times Ltd 2010. http://www.ft.com/cms/s/fd420662-1cb4-11df-8d8e-00144feab49a,dwp_uuid=f0d249... 05/03/2010 Health Investor Monday 22 February, 2010 Competition in the NHS has improved services Hospitals and their patients have benefited from exposure to competition, according to new research by the Centre for Economic Performance at the London School of Economics. The report counters some of the claims raised by the British Medical Associations campaign against the role of the market in the health service. Competition between hospitals to deliver services has produced “clear cut evidence that competition between hospitals produces benefits,” said Carol Popper, one of the study’s authors. By measuring hospital performance using adapted metrics used for private sector companies the authors said “better management procedures produces better hospitals and competition between hospitals produces better management”. ¿Por qué algunas empresas están mejor gestionadas? - Imprimir - Libertad Digital Page 1 of 3 LOS 10 FACTORES CLAVE ¿Por qué algunas empresas están mejor gestionadas? Un nuevo estudio analiza por qué las prácticas de gestión difieren entre empresas y países. Su conclusión es que una combinación de mercados imperfectamente competitivos, empresas familiares, regulaciones administrativas y barreras informacionales explica la persistencia de la mala gestión. ALBERT ESPLUGAS La productividad varía mucho entre empresas y países. Esta divergencia no puede explicarse recurriendo únicamente a la productividad de distintos factores, como el capital intensivo. Un estudio concluyó que sólo la mitad del diferencial de su muestra era función del empleo de distintos factores. Otro trabajo encontró marcadas diferencias de productividad, incluso, dentro de industrias de bienes muy homogéneos, como las cajas y los bloques de hielo. Desde hace décadas ha sido difícil para los economistas atribuir el diferencial entre empresas o países (una vez calculada la contribución de los distintos factores) a causas concretas. “La medida de nuestra ignorancia” es como llamaba el economista Moses Abramobitz a la productividad de un país. Una posible explicación es el uso de innovaciones tecnológicas como nueva maquinaria o patentes, pero incluso controlando estos factores sigue habiendo importantes diferencias. Nicholas Bloom y John Van Reenen aportan una nueva hipótesis en Why Do Management Practices Differ across Firms and Countries?, publicado en el Journal of Economic Perspectives. Según estos autores, las distintas prácticas de gestión de las empresas explican parte de ese diferencial, y el estudio presenta evidencias a favor de esta tesis. La literatura sobre gestión, afirman Bloom y Van Reenen, suele basarse en casos de estudio más que en datos empíricos sistemáticos de empresas y países. Los autores han conducido un conjunto de encuestas durante la pasada década, centrándose en aspectos relevantes de la gestión como la supervisión del comportamiento de los empleados, el establecimiento de los objetivos adecuados o los esquemas de incentivos para promover el buen rendimiento. Tradicionalmente, los economistas han rechazado la hipótesis de Bloom y Van Reenen considerando que es relativamente sencillo y rápido cambiar el modelo de gestión si con ello se consiguen importantes mejoras de productividad. ¿Qué barreras lo impiden? Los autores del estudio sostienen, no obstante, que las diferencias en la gestión están a menudo enraizadas en diferencias más profundas de información, sociales, legales y tecnológicas. Bloom y Van Reenan destacan diez conclusiones en su estudio: 1. Las empresas con mejores prácticas tienden a ser mejores en un conjunto de variables: son más grandes, más productivas, crecen más rápido, y tienen una tasa de supervivencia más alta. 2. Las prácticas de gestión divergen mucho entre empresas y países. La mayor parte del diferencial de la gestión media en cada país es función de la cola de empresas mal gestionadas, más larga en unos que en otros. Por ejemplo, pocas compañías están muy mal gestionadas en Estados Unidos, mientras que en Brasil e India hay muchas empresas en esta categoría. http://www.libertaddigital.com/c.php?op=imprimir&id=1276385636 05/03/2010 ¿Por qué algunas empresas están mejor gestionadas? - Imprimir - Libertad Digital Page 2 of 3 3. Los países y las compañías se especializan en distintos estilos de gestión. Por ejemplo, las empresas americanas puntúan mejor que las suecas en incentivos, pero peor en control del personal. 4. Una fuerte competencia en el mercado tiende a mejorar el nivel medio de la gestión, acortando la cola de empresas muy mal gestionadas y presionando a las recién llegadas a adoptar mejores prácticas. 5. Las multinacionales están generalmente bien gestionadas en cualquier país. También suelen trasplantar sus estilos de gestión a sus filiales. Por ejemplo, multinacionales americanas en el Reino Unido son mejores en incentivos y peor en control de los empleados que las multinacionales suecas en el Reino Unido. 6. Las empresas que exportan al extranjero (pero no producen fuera del país) están mejor gestionadas que las empresas no-exportadores, pero peor gestionadas que las multinacionales. 7. Las empresas de propiedad familiar que sitúan a un miembro de la familia (normalmente el hijo mayor) en la dirección están de media muy mal gestionadas. 8. Las empresas estatales están en general extremadamente mal gestionadas. Empresas en bolsa o privadas suelen estar bien gestionadas. 9. Las compañías que utilizan capital humano más intensamente, medido por el número de trabajadores educados, tienden a tener prácticas de gestión mejores. 10. A nivel de los países, un mercado laboral flexible está asociado a mejores incentivos por parte de la gestión. http://www.libertaddigital.com/c.php?op=imprimir&id=1276385636 05/03/2010 ¿Por qué algunas empresas están mejor gestionadas? - Imprimir - Libertad Digital Page 3 of 3 © Libertad Digital SA Juan Esplandiu 13 - 28007 Madrid http://www.libertaddigital.com/c.php?op=imprimir&id=1276385636 05/03/2010 Printer Friendly Page 1 of 2 From The Times February 26, 2010 Researchers point finger at doctors over manipulating figures Carol Lewis General practitioners have been accused of manipulation to achieve additional payments under the NHS’s quality and outcomes framework (QoF). Under the framework, GPs’ pay has increased and working hours have decreased, while the effect on patient care is unquantifiable, according to research by Hugh Gravelle, a health economist at the University of York, and colleagues from the University of Aberdeen. The framework, which was introduced in April 2004, links treatment for a range of conditions such as heart disease, epilepsy and diabetes to GP pay. However, Professor Gravelle’s damning research paper Doctor Behaviour Under a Pay for Performance Contract: Treating, Cheating and Case Finding? found that it is difficult to measure the effect that the framework has had on the quality of patient care. It points out that the NHS neither routinely collected data on the incentivised activities before its introduction, nor was the scheme given a trial before being adopted nationwide. According to Professor Gravelle: “Pilot schemes with baseline measurements would have revealed if quality was already improving and may have enabled the taxpayer to get better value for money from the scheme.” Yet the framework was welcomed by GPs. Practices received considerable increases in gross income — £1,000 million in payments a year. At the same time, GPs’ normal working hours and job pressure fell sharply. Not surprisingly, their job satisfaction increased. The QoF was “a very good deal for GPs”, Professor Gravelle said. The indicators in the scheme are presented as a ratio of the number of patients treated against the number of patients eligible for treatment. However, patients can be exempt for a number of reasons including being terminally ill, frail, newly diagnosed, intolerant to treatment or failing to turn up to appointments. The research, published in the February edition of the Economic Journal, says that some practices deliberately increased the number of exception reports to increase their indicator scores and, therefore, pay. ? The hospitals with the best managers deliver the best patient care, according to researchers at the Centre for Economic Performance. Hospitals which took people management, monitoring and targetsetting seriously had the best clinical outcomes, shorter waiting times, better financial performance and higher staff satisfaction than those that didn’t. For example, a small (one deviation point) improvement in management scores could mean a fall in deaths from heart attacks from 17 per cent to 16 per cent — or 400 fewer deaths. Management was best in those hospitals where managers had some clinical training and in hospitals with a lot of competing hospitals near by. Contact our advertising team for advertising and sponsorship in Times Online, The Times and The Sunday Times, or place your advertisement. 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VAT number GB 243 8054 69. http://business.timesonline.co.uk/tol/business/industry_sectors/public_sector/article70... 05/03/2010 Empresas do Brasil são mal geridas, diz estudo - Pós-Graduação - Gazeta do Povo PÓS-GRADUAÇÃO Page 1 of 1 Sexta-feira, 05/03/2010 ADMINISTRAÇÃO Empresas do Brasil são mal geridas, diz estudo Pesquisa coloca as companhias brasileiras na 14.ª colocação em ranking das melhores práticas de gestão 03/03/2010 | 00:20 | BRENO BALDRATI Numa lista de 17 países com as empresas mais bem administradas, o Brasil está na rabeira. Na média, as companhias brasileiras têm melhores práticas de gestão apenas do que as da China, Índia e Grécia. Estados Unidos, Alemanha e Suécia estão no topo do ranking. Esse é o resultado de um estudo publicado no mês passado no Journal of Economic Perspectives, realizado pelos economistas Nicholas Bloom, da Stanford University, e John Van Reenen, da London School of Economics. Para mensurar as práticas de gestão, os dois professores realizaram entrevistas em empresas de tamanho médio, com 100 a 5 mil funcionários, escolhidas aleatoriamente. No Brasil, foram 559 firmas pesquisadas. A partir das respostas, eles definiram uma pontuação de 1 (pior prática) a 5 (melhor prática) para 18 práticas básicas de gestão. De maneira geral, essas 18 categorias podem ser divididas em três grandes grupos: monitoramento, metas e incentivos (saiba mais no gráfico). Segundo os autores, uma pontuação elevada mostra que a empresa é mais bem administrada e, na média, também mais produtiva. As empresas brasileiras obtiveram nota média 2,69. Os EUA receberam 3,33. A categoria em que o Brasil se saiu pior foi em incentivos – a capacidade de promover e contratar funcionários. Em parte, a resposta para isso está na legislação trabalhista do país, pouco flexível. O uso do capital humano, medido por trabalhadores mais educados, também afeta o desempenho brasileiro. Quanto maior o grau de escolaridade dos gerentes e dos funcionários, em geral também maior a nota que a empresa recebe. “Nossa crença é de que mais educação empresarial básica – por exemplo, sobre questões de orçamento, análise de dados e práticas de recursos humanos – poderia ajudar a melhorar a gestão em muitos países, especialmente nos em desenvolvimento”, afirma os autores. Outro problema brasileiro foi o tamanho da “cauda longa” – o grande volume de empresas muito mal gerenciadas. Brasil e Índia têm um número razoável de empresas bem administradas, especialmente multinacionais e exportadoras, duas condições diretamente ligadas a uma boa nota, mas tiveram a média puxada para baixo pelo grande número de empresas muito mal administradas. Esse mal gerenciamento está relacionado a uma série de fatores, entre eles a quem é o proprietário da firma. As empresas familiares que nomeiam um membro da família (especialmente o filho mais velho) como o CEO e as empresas do governo, por exemplo, formam o grupo com a piores notas. Esse fato complicou a situação brasileira. Enquanto nos países ricos – Alemanha, Japão, Suécia e Estados Unidos – o número de empresas desse grupo representa 20 % a 30% da amostra; para Brasil, Portugal, Itália e Grécia ele equivale a 60%. “Uma explicação para essa diferença é que o subdesenvolvimento do mercado financeiro e a fraqueza da força da lei em muitos dos países em desenvolvimento torna extremamente difícil a separação entre propriedade e controle. Por exemplo, famílias podem ficar relutantes em contratar gerentes de fora porque a lei não é forte o suficiente para protegê-las em casos de roubo”, escrevem os autores. As empresas com os preços das ações cotadas em bolsa ou de propriedade de firmas de private equity foram as que foram mais bem avaliadas. Concorrência Segundo o estudo, as empresas que enfrentam mais concorrência em geral receberam as melhores notas. Quando a competição no mercado de um determinado produto não é intensa, argumentam os autores, uma empresa com pouca produtividade (e mal administrada) é capaz de permanecer no mercado. FECHAR http://www.gazetadopovo.com.br/posgraduacao/conteudo.phtml?tl=1&id=979092&tit... 05/03/2010 Measuring management practices | vox - Research-based policy analysis and comment... Page 1 of 1 vox Research-based policy analysis and commentary from leading economists Measuring management practices John Van Reenen Interviewed by Romesh Vaitilingam 5 March 2010 How important are management practices in driving the performance of firms and the productivity of nations across Asia, Europe and North America? John Van Reenen, director of the Centre for Economic Performance (CEP) at the London School of Economics, talks to Romesh Vaitilingam about CEP’s research programme on the economics of management and productivity. The interview was recorded in London in February 2010. Listen (22 minutes 38 seconds) Download Related research here. (MP3 file 10.3MB) Related article(s): z Why some do IT better z Can European firms close their ‘management gap’ with the US? Transcript Not currently available. Topics: Competition policy, Industrial organisation, Productivity and Innovation Tags: Comments http://www.voxeu.eu/index.php?q=node/4714 05/03/2010