Health manpower management最新文献

Reports on a project which looked into the impact of "local pay" on four different types of Trust. Notes that all four were working towards ameliorating the perceived threat of local pay. Reports the use of various methodological approaches such as semi-structured interviews and a team diagnostic exercise and comes up with numerous findings.

Explains that considerable recent publicity has been given to the claim that around 70 per cent of business process re-engineering exercises are unsuccessful, mainly because of failure to take human factors into account. Outlines the work undertaken in a single specialist surgical service, within an acute services National Health Service Trust, and the outcomes achieved. Suggests that there are points arising from the project to be learned both by the Trust and by other health-care employers contemplating similar exercises: in particular, deciding objectives; the preparation undertaken prior to the project; and detailed post-implementation benefit analysis.

Tests the theory that owners (hospital, physician, insurance) of vertically integrated health maintenance organizations (HMOs) might substitute towards production of their own specialty goods. Uses data from various sources in the USA. Determines the impact of ownership on factors such as average physician ambulatory services per enrollee and average hospital days per enrollee. Concludes that policymakers need to encourage the development of standard publicly available quality measures to intensify competition and eliminate excess profits accruing to provider-owners who substitute towards production of their own goods.

Effective strategic analysis of existing and potential services requires a framework which is relevant and understandable to both clinicians and senior managers. Our work with NHS trusts has developed a framework based on analysis of services into four principal service streams--emergency general hospital, non-emergency general hospital, specialist general hospital and tertiary. Relating service streams to clinical specialties provides a matrix which can provide a basis for an initial analysis of the current and prospective clinical services portfolio, allowing drilling down into the detail and back up to the overall picture. Portfolio effectiveness is assessed by considering overall viability consisting of three interrelated elements--clinical, market and financial viability. The interrelationship of service streams, clinical specialties and viability allows the trust board and key clinicians to share insights into the current and potential systemic linkages between these three elements and to develop a vision of future strategic direction.

Management of the NHS is necessary and vital to effective delivery of health services. It is not a process that can be avoided, whoever does it. New Labour needs effective managers in the NHS if they are to bring about the changes they want to see. Manager bashing, which New Labour is showing signs of continuing, is counter productive and encourages a climate of threat for managers which subsequently translates into bad management practice with its inevitable consequences for service quality and productivity. The NHS badly needs a positive long-term strategy of serious investment in individual and organizational development. It is a question of balanced investment between the long-term management capability of the NHS and immediate patient care. The major issues of rationing, priorities and the balance between health and health services will always be part of the difficult national and local management task. Some move by politicians in the direction of open recognition of these difficulties and the burden they place on the skill, will and courage of managers could go a long way to building a caring management culture.

The new education commissioning system in England is designed to deal with the "big numbers" of professional education, yet also applies to management development. Reviews national advice in this field. Suggests that management development is unlikely to feature highly on the education commissioning agenda. Proposes that changes in higher education and among NHS employers are likely to lead to greater flexibility in management education, but that opportunities will only be taken if both parties show initiative and imagination.

Problems in recruiting and retaining professional staff are an ongoing concern to many NHS Trusts and professional heads of service. There is evidence from a wide variety of sources that direct line managers are frequently cited as a source of worker's stress and a cause of staff turnover. Reviews these issues and suggests subordinate appraisal of managers as one possible response.

Notes the importance of continuous improvement as a concept to guide management and that this concept requires numerous components to make it work. Picks out the role of information management as a key area, citing factors such as the creation of an "information culture" as being of major importance. Looks at the path followed by some Trusts in pursuit of this "information culture" wherein staff gained an improved insight into the use of information as a management tool.

Discusses the interpretation of nursing statistics, the problem of counting how many nurses there are in the workforce, and the need to be aware of how statistics are compiled when presenting numerical data to support arguments relating to nursing and the nursing workforce. Argues that NHS workforce statistics provide considerable evidence for claiming that there is a significant decline in the number of nursing staff doing the work of nursing in the NHS. Explains that although there was an increase in the number of qualified nurses working in the NHS throughout the 1980s (over a ten-year period the number of qualified nurses increased by 22 per cent), the increase in qualified nursing staff has not compensated for the loss of student learners in the workforce. Emphasizes that during the last three years for which figures are available, however, these gains have been wiped out, and the number of qualified nurses has declined to pre-Project 2000 levels.