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Biomedical subjects

Maria Goddard

Publications and source records attributed to Maria Goddard.

12 recordsLinked to original sources
PubMed2006

Decentralising the NHS: rhetoric, reality and paradox.

PURPOSE: The purpose of this research is to examine the issues of decentralisation in the NHS. DESIGN/METHODOLOGY/APPROACH: Evidence was gathered from an empirical study in order to illustrate the effect of policy reform on relationships at both the central and the local level. In this paper issues were examined in the context of two reforms at the heart of the decentralisation agenda in the English NHS: earned autonomy and the introduction of foundation hospitals. FINDINGS: Past and current policy in the NHS reflects elements of both centralisation and decentralisation. The tension created by such opposing forces has an impact not only on inter-organisational partnership working but also on the balance of power within local health economies. ORIGINALITY/VALUE: Attempts to control the NHS exhibit unresolved contradictions and tensions. This research showed that the challenge for policymakers, managers and clinicians is to manage such tensions.

Empirical Research↗
PubMed2006

Exploring the determinants of NHS performance ratings: lessons for performance assessment systems.

OBJECTIVES: A basic tenet of effective performance management is that decision makers should be held responsible only for aspects of performance over which they have control. We examine the degree to which variations in the performance of health care organizations are explained by a range of factors that are subject to differing degrees of managerial control. METHODS: We use multiple regression methods and data on 304 National Health Service (NHS) Primary Care Trusts (PCTs) in England for 2002/03 to analyse the relationship between their performance, as measured by 'star ratings' and nine key performance targets, and a large number of explanatory variables. We classify the explanatory variables into five groups along a spectrum from 'no managerial control' to 'total managerial control'. We also analyse the relationship between PCTs that are service purchasers and their main providers to assess the degree to which their performance is linked. RESULTS: For all of the key performance targets, most of the variation in performance is unexplained, although variables in groups 1, 2 and 3 (less managerial control) explain the largest proportion of variation. We find some evidence that socioeconomic and geographic factors have an impact on performance. We also find a positive relationship between the performances of purchaser and provider organizations. CONCLUSIONS: The star ratings did not allow for the different environmental circumstances within which PCTs operate and which affect their performance. Policy-makers should exercise caution in using such performance indicators to regulate health care organizations.

England↗
PubMed2005

How robust are hospital ranks based on composite performance measures?

BACKGROUND: Composite indices of healthcare performance are an aggregation of underlying individual performance measures. They are increasingly being used to rank healthcare organizations. Although composite indicators present the "big picture" in a way that is easy to interpret, misleading conclusions may be drawn if attention is not paid to key methodological issues in their construction. OBJECTIVES: We examine variability in performance measures in the context of the construction and use of composite measures. We illustrate how variability in the underlying data and the resulting composite may undermine the robustness of performance measures in health care. We also illustrate how variation in the methodological rules applied to aggregate the individual indicators can have an important impact on composite scores. METHODS: We use data for 117 English acute hospitals to illustrate the generic methodological issues. The variance in performance measures is partitioned into "controllable" and "uncontrollable" elements. We create a composite index from the underlying performance indicators and use Monte Carlo simulations to examine the robustness of the composite. RESULTS: Random variation beyond the control of organizations gives rise to considerable uncertainty in hospital scores. Composites are also sensitive to changes made to the weighting system and to the aggregation rules. Some hospitals can jump almost half of the league table as a result of subtle changes. CONCLUSIONS: Great care is warranted in interpreting the results of composite performance measures. Suggestions for their future development are made.

Benchmarking↗
PubMed2005

Decentralization strategies and provider incentives in healthcare: evidence from the english national health service.

INTRODUCTION: This article examines the incentive effects of delegating operational and financial decision making from central government to local healthcare providers. It addresses the economic consequences of a contemporary policy initiative in the English National Health Service (NHS)-earned autonomy. This policy entails awarding operational autonomy to 'front-line' organisations that are assessed to be meeting national performance targets. In doing so, it introduces new types of incentives into the healthcare system, changes the nature of established agency relationships and represents a novel approach to performance management. METHODS: Theoretical elements of a principal-agent model are used to examine the impact of decentralization in the context of the results of an empirical study that elicited the perceptions of senior hospital managers regarding the incentive effects of earned autonomy. A multi-method approach was adopted. In order to capture the breadth of policy impact, we conducted a national postal questionnaire survey of all Chief Executives in acute-care hospital Trusts in England (n = 173). To provide added depth and richness to our understanding of the impact and incentive effects of earned autonomy at an organisational level, we interviewed senior managers in a purposeful sample of eight acute-care hospital Trusts. RESULTS: This theoretical framework and our empirical work suggest that some aspects of the earned autonomy as currently implemented in the NHS serve to weaken the potential incentive effect of decentralization. In particular, the nature of the freedoms is such that many senior managers do not view autonomy as a particularly valuable prize. This suggests that incentives associated with the policy will be insufficiently powerful to motivate providers to deliver better performance. We also found that principal commitment may be a problem in the NHS. Some hospital managers reported that they already enjoyed a large degree of autonomy, regardless of their current performance ratings. We also found evidence that the objectives of providers may differ from those of both the central government and local purchasers. There is, therefore, a risk that granting greater autonomy will allow providers to pursue their own objectives which, whilst not self-serving, may still jeopardize the achievement of strategic goals. CONCLUSION: It is apparent that the design and implementation features of decentralizing policies such as earned autonomy require careful attention if an optimal balance is to be struck between central oversight and local autonomy in the delivery of healthcare.

Hospitals, Public↗
PubMed2003

Public disclosure of comparative clinical performance data: lessons from the Scottish experience.

There is growing international interest in making information available on the clinical quality and performance of health care providers. In the United States of America, where public reporting is most advanced, comparative performance information in the form of 'report cards', 'provider profiles' and 'consumer reports' has been published for over a decade. In Europe, Scotland has been at the forefront of releasing clinical performance data and has disseminated such information since 1994. This paper reviews the Scottish experience of public disclosure and distils the key lessons for other countries seeking to implement similar programmes. It is based on the findings of the first empirical evaluation of a national clinical reporting initiative outside the United States. The study examined the impact of publication of Scottish (CRAG) clinical outcome indicators on four key stakeholder groups: health care providers, regional government health care purchasers, general practitioners and consumer advocacy agencies. We conclude that those responsible for developing clinical reporting systems should not only pay close attention to developing technically valid and professionally credible data which are tailored to the information needs of different end users, but should also focus on developing a suitable incentive structure and organizational environment that fosters the constructive use of such information.

Breast Neoplasms↗
PubMed2002

Private concordat. Flexible friends.

A survey of acute trusts and health authorities suggests that expenditure in the private sector has more than doubled since the signing of the concordat in October 2000. But it still represents less than 1 per cent of total acute spending. Most of the spending was for orthopaedic surgery, made under short-term, cost-per-case deals. The need for increased capacity was the main motive for using the independent sector. More than three-quarters of respondents cited prices in the independent sector as a barrier to greater collaboration. There is little evidence of NHS organisations and those in the independent sector forming partnerships for long-term service planning.

Contract Services↗
PubMed2002

Performance measurement and improvement in health care.

Performance measurement is playing an increasingly important role in health care systems around the world, and many countries are designing and implementing measurement systems to achieve a range of objectives. Yet, the production of research evidence to inform practice has not kept pace with this policy development. In this paper we employ a simple model of performance measurement that focuses on issues related to the measurement of performance; the analysis and interpretation of performance information; and the action, which occurs as a consequence. The framework is used to analyse the key elements of the performance measurement process, drawing on experience and evidence from the United Kingdom. By drawing on the cross-national experience, individual health systems can learn from examples of good practice and avoid implementation errors made elsewhere.

Health Policy↗