Improving performance in the NHS

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2773 (Published 16 July 2009) Cite this as: BMJ 2009;339:b2773
  1. Tim Wilson, partner, health advisory
  1. 1PricewaterhouseCoopers LLP, London WC2R 0AF
  1. tim.wilson{at}uk.pwc.com

    Staff ownership has appeal but is insufficient and implementation has risks

    It seems too obvious to state that the performance of healthcare systems is related to the actions of clinical staff, mostly doctors. Policy makers and health system leaders continually seek ways to optimise clinical behaviours but never seem to succeed in creating an environment where high performance is reliably achieved. Structural change, quality improvement programmes, incentives (financial and otherwise), choice and competition, integrated care, benchmarking, feedback, peer review, professional development, and a myriad of other tools have been tried, but none seems to have a consistent effect.1

    In seeking another solution, the Nuffield Trust has analysed the benefits of staff ownership.2 The authors pick up on the problem in their review of attempts by the NHS to engage or involve staff and the surveys that continually articulate a sense of disengagement. Considering engagement or involvement as something that needs to be done to or with staff misses the point, however: the NHS is its staff. The report analyses performance levels in a range of organisations where, through their ownership structures, the staff are the organisation itself. They focus especially on John Lewis (department stores, supermarkets, …

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