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How we took control and became more efficient

BMJ 2011; 342 doi: (Published 31 May 2011) Cite this as: BMJ 2011;342:c5072
  1. Michael Griffith, consultant cardiologist,
  2. Jonathan Townend, consultant cardiologist
  1. 1Department of Cardiology, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
  1. michael.griffith{at}

The years of increased NHS spending under the last Labour government delivered an increase in the volume of healthcare, but no improvement in efficiency and productivity.1 Many factors contributed to this situation, but a major one was probably the lack of any attempt to incentivise clinical staff. Instead, a system of mandatory performance targets has been imposed from the centre, often leading to unintended adverse clinical consequences. Additionally, the allocation of departmental funding on the basis of the past year’s spending creates a perverse incentive to increase rather than reduce costs. The disadvantages of such a centrally planned economic system on workers’ motivation have been well described.2 3

Personal financial gain is a widely used motivator and is very powerful, but that power can lead to inappropriate clinical decisions. The suspicion that the saving of money based on personal financial gain results in inappropriate and even inferior care has harmed the relationship between patient and doctor.4 5 …

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