Rapid Responses to:

EDUCATION AND DEBATE: Donald Light and Michael Dixon Making the NHS more like Kaiser Permanente BMJ 2004; 328: 763-765 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

It's the quality of management that differs

James A Dunbar   (26 March 2004)

shome mishtake, shurely ?

L S Lewis   (9 August 2004)

It's the quality of management that differs 26 March 2004
James A Dunbar, Professor of Rural Health Greater Green Triangle UDRH, Flinders & Deakin Universities, Vic 3280, Australia Send response to journal: Re: It's the quality of management that differs	One simple fact unassailably indicts the NHS. For the cost of an average family’s National Insurance contribution to the NHS, Kaiser provides full cover to a much higher standard. Kaiser gives more and better for the same money. As if that wasn’t enough to damn the NHS, consider Labour’s boast to raise spending to average European levels. Scotland has been spending at the average European level but does not achieve the same standards. One has to ask why? As the authors point out, one reason is the quality of management. With a few notable exceptions, NHS managers are not leaders far less clinical leaders. Indeed they often show the characteristics of notional leaders, namely the ability to climb the greasy pole and stay on top by any means. In business or the armed forces, notional leaders are found out early and don’t stay on top for long. Real leaders have different characteristics that all recognise. The internal market revealed to many doctors how poor the management was – barely trained, clinically ignorant, indecisive and risk averse – managing politics rather than performance. Worse still, these managers align with the directors of finance who hate to see budgets change. While the rest of the world devolves budgets and empowers teams, the NHS centralises control. Kaiser recognises that clinical improvement means clinicians changing the budgets, but the NHS financial dinosaurs cling to the status quo. Doing more of the same and expecting a different result is a form of madness common in NHS management. Competing interests: Refugee from the NHS now working in Oz - former Medical Director and GP in Scotland.
shome mishtake, shurely ? 9 August 2004
L S Lewis, Primary Care Medical Adviser Surgery, Newport, Pembrokeshire, SA42 0TJ Send response to journal: Re: shome mishtake, shurely ?	"However, the admission rates for acute myocardial infarction, heart failure, and urinary infection were so much higher in Kaiser than the NHS that specialists in the two systems could be practising different types of medicine" turning the whole case on its head ? [ Ham's figures were t'other way about !! ] Competing interests: I work for the NHS