Intended for healthcare professionals


Supporting poorly performing NHS hospitals to improve

BMJ 2013; 347 doi: (Published 25 September 2013) Cite this as: BMJ 2013;347:f5830
  1. Chris Ham, chief executive
  1. 1King’s Fund, London W1G 0AN, UK
  1. c.ham{at}

High performing hospitals face obstacles and risks in providing support

Harvard Business School guru Clayton Christensen and his coauthors once famously described hospitals as “some of the most managerially intractable institutions in the annals of capitalism.”1 Recent reports on NHS hospitals in England failing to provide acceptable standards of care underline the simple truth behind this assertion.2 3 With other hospitals also likely to experience problems in delivering care of the right quality as the government’s new inspection regime for hospitals is implemented and financial pressures increase, how can poorly performing hospitals be helped to improve?

Health Secretary Jeremy Hunt’s answer is to ask high performing NHS hospitals to provide support to poorly performing hospitals to enable them to improve the quality and safety of patient care. Support will be provided initially to the 11 NHS trusts with high mortality rates highlighted in the Keogh review as requiring “special measures” to turn around their performance.3 High performing hospitals will work under improvement contracts through which they will be reimbursed for their time and rewarded through an incentive fund if they deliver …

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