Biomedical subjects
Publications and source records attributed to Nigel Edwards.
The central argument of the new book by renowned US academics Michael Porter and Elizabeth Olmsted Teisberg is that the US health system is broken because rather than improving quality and efficiency, it focuses on budgetary battles. HSJ gathered together six leading healthcare insiders to discuss whether his diagnosis is applicable to the NHS. Nick Edwards was there.
While some forms of public-private partnerships are a feature of hospital construction and operation in all countries with mixed economies, there is increasing interest in a model in which a public authority contracts with a private company to design, build and operate an entire hospital. Drawing on the experience of countries such as Australia, Spain, and the United Kingdom, this paper reviews the experience with variants of this model. Although experience is still very limited and rigorous evaluations lacking, four issues have emerged: cost, quality, flexibility and complexity. New facilities have, in general, been more expensive than they would have been if procured using traditional methods. Compared with the traditional system, new facilities are more likely to be built on time and within budget, but this seems often to be at the expense of compromises on quality. The need to minimize the risk to the parties means that it is very difficult to "future-proof" facilities in a rapidly changing world. Finally, such projects are extremely, and in some cases prohibitively, complex. While it is premature to say whether the problems experienced relate to the underlying model or to their implementation, it does seem that a public-private partnership further complicates the already difficult task of building and operating a hospital.
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One of the real problems for the student of hospitals is that there is not really agreement on what a hospital is and what's it for. There is also very little research and even less evidence about where hospitals are going. What many futurologists like to say is that the hospital is a dinosaur and on its way out. However, just because something can happen doesn't mean it will, especially as dinosaurs were around for 125 million years. Most change is evolutionary and therefore more incremental and often slower than we think. In this presentation, an attempt will be made to apply some of the disciplines of evolutionary biology to hospitals.
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There is a long history of problems in the relationship between doctors and managers. The reasons for this stem from the values of each group and the effect that these have on their views on a number of key aspects of healthcare and its delivery. Managers have been seen as the malign embodiment of changes in society and the instrument of the wishes of governments, which are often viewed with suspicion. High-quality healthcare is dependent on a productive partnership between doctors and managers and on doctors being prepared to take leadership roles. Both groups have skills and knowledge vital to the other, so each needs to recognise the strengths of the other and find ways to develop a productive partnership. Clinical work can be improved by the application of management techniques, and management would benefit from more clinical leadership.