Is there a manager in the house?

Good hospitals require good managers, preferably with some clinical training. That's one of the conclusions of a recent study of NHS hospital management into the impact of competition on leadership practices in the health service. The study from the Centre for Economic Performance is based on a survey of clinicians and hospital managers and concludes that good management results in better clinical outcomes. It says that hospitals with higher management scores have better outcomes, such as lower mortality rates from emergency heart attacks, shorter waiting times, better financial performance and higher staff satisfaction, and it recommends that hospitals consider drawing more senior managers from the ranks of clinical staff, as happens in the US. The results will help to shore up the confidence of health service managers, who often come under fire in relation to frontline services. Wide variations in the management of NHS hospitals The study shows that there are wide variations in the management of NHS hospitals and that small variations in performance make a big difference to outcomes. Improving management by a single point on the researchers' scoring scale is associated, they say, with a fall in the death rate from heart attacks from 17% to 16% – and that could result in some 400 fewer deaths a year. The study also concludes that competition does work in some way. Hospitals faced with a larger number of nearby competing hospitals have much better management practice, it says. "Even in a regulated environment, where monitoring agencies and regulators decide how well a hospital is performing, the number of hospitals will have an impact," says the study. "In an area with many hospitals, it is easier to assess the performance of each hospital by comparing it with its neighbours." A more competitive environment also tends to attract high-quality managers: "With more hospitals nearby, it is easier for managers to look out for employment opportunities." These findings on the competitive nature of hospitals may have implications for the proposals to centralise clinical practice into larger centres of excellence, which by definition would have fewer close "competitors". One of the less surprising conclusions in the report is that hospitals located in marginal constituencies are much less likely to be closed than hospitals in safe seats.