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More and Better Management Is Key to Fixing the NHS

Investing more in good managers and appropriate IT may be a far more effective way to improve the working lives of doctors and nurses than recruiting more staff,// according to an article in this week’s BMJ.

Those who are against reforming the NHS blame problems on a lack of resources, bureaucracy, government interference in clinical judgement, and the “greedy” private sector. But there is evidence that better management makes more difference than more investment, writes Management Consultant, Stephen Black.

The core of the anti-reformers’ argument is that we should spend more on “frontline” staff, but this assumes that the only thing that matters is how many doctors and nurses we have. This assumption is demonstrably untrue and pernicious – distracting the NHS from simple changes in working practice that could dramatically improve patient care, he says.

He argues that changing how a hospital is organised can improve the quality, quantity and speed of patients’ care more than the most extravagant spending on doctors and nurses does. Evidence for this can be seen in two areas in particular: emergency departments and bed management.

Independent data from A&E departments show no relation at all between staffing levels and performance. Research also shows that hospitals could solve their bed problems quickly and cheaply by organising beds better.

In other words, management matters. And just increasing resources is a poor way to fix performance problems, which is why the suggestion to run the already under-managed NHS with even fewer managers is ludicrous, he says.

A well organised hospital is a better place to work than a badly organised one with twice the number of staff. Investing more in better organisation, good managers, and appropriate IT may be a far more effective way to improve the working lives of doctors and nurses than recruiting more doctors and nurses, he concludes.

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