Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Hitting nails on heads
- Neville W Goodman (16 August 2006)
-
Health Care Productivity - helpful rhetoric or misleading reality?
- David Kernick (25 August 2006)
-
Useful and useless definitions...
- stephen black (25 August 2006)
-
Along a more positive vein
- Kerry Hickson (12 September 2006)
|
|
|||
|
Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
Send response to journal:
|
Is the lack of responses to this editorial a sign of the resigned apathy among the readership, who recognise the implications of this sentence? "The Department of Health recognises such theoretical and practical concerns but, despite this, current political necessity may over-ride considered judgment." In other words: the Department has to continue doing something that has no validity whatever. The corollary is that productivity can be interpreted in whatever way one likes, for whatever political gain one thinks can be made. Tony Blair may trumpet that ideology is dead, and that what matters is "what works"; but, as "what works" is interpreted through an ideological prism, we are still left with ideology. Competing interests: None declared |
|||
|
|
|||
|
David Kernick, General Practitioneer St Thomas Health Centre, Exeter EX4 1HJ
Send response to journal:
|
Over the past decade, a number of phrases have entered the health service vocabulary and achieve their potency through a political ambivalence that evokes popular appeal. Who could be against any "quality" initiative, a reconfiguration of services based on "community," a clinical decision focussed on "patient-centredness" or a programme that is "pursuing perfection?" Until recently, health service “productivity” was a key component of this deceptive mantra but it is reassuring to see the concept under serious scrutiny. In practice, there are overwhelming limitations to applying a rational and linear analytical framework (a system can be understood by breaking it down into its component parts where there is a simple relationship between cause and effect) to the complex non-linear environment of health care. This simplistic approach can lead to dysfunctional consequences and lock policy makers into analytical modes that may not be appropriate for a system where things may not be as certain as we may like to think. An alternative approach would be to return to a focus on process. But from a perspective that sees both health and health care productivity emerging from the relationships we have with each other and accepting that the best we can hope for is a flavour of productivity. Or as the economist Keynes suggested, focussing on being vaguely right not precisely wrong. Competing interests: None declared |
|||
|
|
|||
|
stephen black, managemetn consultant london sw1w 9sr
Send response to journal:
|
The trouble with macroeconomic definitions of productivity (ie the ones where we make arbitrary assumptions about the "value" of health improvement) is that they are useless for making decisions about anything and they give simpler definitions of productivity a bad name. The NHS needs good local measures of productivity if it is ever going to improve anything. If hospital A gets twice as many hip replacements per operating theatre as hospital B (and the quality and casemix is the same) then hospital B might want to work out why. These differences exist between hospitals, between consultants, between departments, and they are often large differences. Sometimes there are good explanations (Consultant A only does complex cases) but often there are no good reasons. Experts who understand the clinical processes can readily identify those differences that can be emulated by the less productive. Real and significant improvements in the operational performance of the NHS (as good practice is replicated) could be obtained if more attention were paid to measuring and publishing these local productivity metrics. We shouldn't let the macroeconomic gobbledygook blacken the name of useful productivity metrics for operational improvement. Competing interests: Management consultant working in health |
|||
|
|
|||
|
Kerry Hickson, PhD student LSE
Send response to journal:
|
Considering the productivity of healthcare provision, although commendable in its objectives, is perhaps not the premier index for evaluating the NHS, or any other service that has utility value in addition to production. Measuring productivity is unlikely to achieve the most indicative results about the performance of the NHS because optimising output from a fixed input is not the same as providing a good quality healthcare system, due to the nature of health in an individual’s utility function. Any measure of healthcare productivity that fails to evaluate the utility it generates for the population is seriously misleading – in general and also for the purposes of political rhetoric. A more desirable and symptomatic approach would be to consider the output of the NHS in terms of the value that it adds to individual lives, the subsequent population as a whole, and ultimately the economy, i.e. through some from of extended Gross Domestic Product (GDP), which measures the output of the NHS as well as the input. Currently only the cost of the NHS is included in GDP with no indices for the output or benefit of the NHS. Black et al indicate the paucity of outcomes and consumer satisfaction data, which make valuing the output of the NHS complex and ambiguous. Without a regular national health interview survey it is near impossible to consider the value of health improvements and the subsequent value of the NHS, and also how this differs under different political parties. However, my initial research has yielded significant results, where approximates for improvements in the nations health (both mortality and morbidity) over the twentieth century add about 1.2 percent to compound average annual GDP growth rates. This emphasises the importance of considering the output of the NHS and the necessity of collecting data on the populations’ perception of health processes and outcomes in order to facilitate more accurate estimates about the merits of the NHS. Although considering the contribution of improved health to economic development (i.e. GDP) will always be plagued by some assumptions and subjectivity biases (as Black et al highlight), it would certainly provide a pellucid indication of the value of the NHS, and perhaps dampen accusations of an improvident system (made by opposition political parties). This approach also provides a measure of health which considers the value of outputs, both in relation to the cost of inputs and the quality of outputs, and in doing so avoids the shortcomings associated with applying strict productivity measures to the NHS. Kerry Hickson: k.hickson1@lse.ac.uk Competing interests: None declared |
|||