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Management in healthcare

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Management in healthcare

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Management in healthcare

  1. 1. Management Matters in Healthcare Brought to you by
  2. 2. Agenda Measuring management practices in healthcare2 Describing management across hospitals3 “Drivers” of management practices4 Implications for policy makers and others5 An overview1 Brought to you by
  3. 3. We are extremely grateful for the support received from our funders Brought to you by
  4. 4. Management and performance are tightly linked in our research on over 6,000 industrial firms globally 1 Sales per employee 2 Return on Capital Employed 3 Tobin’s Q assuming constant book value 8.7 11.5 Sales growth % 5.6 7.9 Market share growth Index 100 171 Productivity1 Indexed 100 106 Management score Management score + 1 Management score Management score + 1 Capital market valuation3 Index 100 126 Management score Management score + 1 ROCE2 % Brought to you by
  5. 5. 5 Healthcare management practice findings 5 ▪UK healthcare management practice: − Good UK average score Vs others − Large intra-country variation creates a real opportunity for improvement There is large variation ▪5 factors are associated with better management practice: − Share of clinically trained managers − Degree of competition − Hospital size − Managerial autonomy − Hospital ownership Improvement is possible ▪Management practice is strongly related to: − Clinical outcomes − Patient satisfaction − Hospital financial performance Management really matters Brought to you by
  6. 6. Agenda Describing management across hospitals3 “Drivers” of management practices4 Implications for policy makers and others5 An overview1 Measuring management practices in healthcare2 Brought to you by
  7. 7. Our hypothesis was that management practices were key drivers of hospital performance Codify good management practices Select and train a team of interviewers Correlate management and performance Assess quality of management practices Select and target hospitals ▪Based upon our Management Matters in Industrials work: ▪Defined 20 scoring dimensions focusing on: – Lean hospital operations – Performance management – Effective talent management Brought to you by
  8. 8. Our hypothesis was that management practices were key drivers of hospital performance Codify good management practices Select and train a team of interviewers Correlate management and performance Assess quality of management practices Select and target hospitals ▪Team of: – 24 MBA and post-graduate management students – Dedicated, highly skilled and trained interviewers Brought to you by
  9. 9. Our hypothesis was that management practices were key drivers of hospital performance Codify good management practices Select and train a team of interviewers Correlate management and performance Assess quality of management practices Select and target hospitals ▪Randomly selected public and private hospitals across 7 countries ▪Focused on assessments at the specialty level Brought to you by
  10. 10. Our hypothesis was that management practices were key drivers of hospital performance Codify good management practices Select and train a team of interviewers Correlate management and performance Assess quality of management practices Select and target hospitals ▪Conducted almost 1,200 interviews that: – Were ‘double blind’ – Targeted unit-level managers – Focused upon Cardiology and Orthopaedics Brought to you by
  11. 11. Our hypothesis was that management practices were key drivers of hospital performance Codify good management practices Select and train a team of interviewers Correlate management and performance Assess quality of management practices Select and target hospitals ▪Examined management scores with data that is: – Publically available – Obtained from independent sources Brought to you by
  12. 12. We use a hospital speciality–level assessment tool to evaluate management practices Management practices Hospital Operations Management Performance and target management Talent and People management Example dimensions evaluated Performance dialogue and review Interconnection of targets Consequence measurement Target balance Performance tracking 3. Performance is continuously tracked and communicated, formally and informally, to all staff using a range of visual management tools 1. Measures tracked do not indicate directly if overall hospital objectives are being met. Tracking is ad hoc 2. Most key performance indicators are tracked formally. Tracking is overseen by senior staff Dimension Scoring criteria Brought to you by
  13. 13. Hospital operations Manage- ment The overall hospital management practice score is the average of assessments across 20 dimensions Performance manage- ment Talent manage- ment Dimensions Score 1. Lay out of patient flow 2. Rationale for introducing standardisation and/or pathway management 3. Standardisation and protocols 4. Continuous Improvement … 5. Good use of human resources 2 3 2 3 4 7. Consequence management 8. Quality of targets 9. Target stretch 10. Clarity of goals and measurement 11. … 3 2 3 3 13. Rewarding high performers 14. Promoting high performers 15. Making room for talent 16. … 3 4 3 4 Overall management practice score, on scale of 1–5, is calculated from average across all 20 dimensions Brought to you by
  14. 14. We interviewed almost 1,200 hospitals across 7 countries 55 130 158 166 175 184 326 Italy Sweden U.S. U.K. Canada Number of interviews Germany France Brought to you by
  15. 15. Agenda “Drivers” of management practices4 Implications for policy makers and others5 An overview1 Measuring management practices in healthcare2 Describing management across hospitals3 Brought to you by
  16. 16. There is a strong relationship between management practice and health outcomes 3rd quartile 95 Bottom quartile 105 Management practice score Top quartile 90 2nd quartile 95 UK heart attack mortality rates Brought to you by
  17. 17. 17 Good management is correlated with better clinical and financial performance ▪7% reduction in risk adjusted 30 days AMI mortality rates1 ▪14% increase in EBITDA per bed ▪0.8 increase in the percentage of people that would recommend the hospital A one point increase in management practice is associated with: UK Hospitals US Hospitals ▪6.5% reduction in risk adjusted 30 days AMI mortality rates ▪33% increase in income per bed ▪20% increase in the probability that the hospital is above average in terms of patients satisfaction Brought to you by
  18. 18. 18 There is a wide variation in average hospital management practice score by country 2.40 2.48 2.52 2.64 2.68 2.82 3.00 0.75 0.86 1.06 0.99 1.24 1.22 1.43 France Italy Canada Germany Sweden UK US Average with controls Average Management practice score – by country Brought to you by
  19. 19. 2,000 3,000 4,000 5,000 6,000 Management practice score 0.90.8 1.51.41.31.21.11.0 US UK Sweden Italy GermanyFrance Canada 19 The UK achieves high management practice scores relative to direct health expenditure Government health expenditure per capita, 2006 $ Brought to you by
  20. 20. 20 There is an even bigger variation of management practice scores within countries Brought to you by
  21. 21. Agenda Implications for policy makers and others5 An overview1 Measuring management practices in healthcare2 Describing management across hospitals3 “Drivers” of management practices4 Brought to you by
  22. 22. Hospitals with more clinicians as managers have better management 1.01 1.00 0.97 Proportion of managers with a clinical degree Top quartile 1.02 3rd quartile2nd quartileBottom quartile Management score relative to national mean Brought to you by
  23. 23. 23 Increases in clinically trained managers is correlated with improved management practices 9.35 8.38 1.21 0.31 Change in the proportion of managers with a clinical degree1 Change in management practice score1 Top quartile3rd quartile2nd quartileBottom quartile 1 Percent Brought to you by
  24. 24. 24 There is wide variation in the prevalence of clinically trained managers by country 57.90 63.77 71.45 73.75 74.11 93.14 US Canada Sweden Germany France UK 1 Italy excluded as it is a legal requirement that all general managers have clinical degrees Percentage of managers with a clinical degree1 Brought to you by
  25. 25. 25 Tougher competition appears to be good for management 1 to 5 2.69 None 2.59 Number of competitors1 More than 10 2.90 5 to 10 2.82 1 As perceived by the manager. Management practice score Brought to you by
  26. 26. 2626 There is a strong relationship between hospital size and management practice Number of employees1 >1,499 2.80 500-1,499 2.71 100-499 2.65 <100 2.44 1 Directly employed by the hospital Management practice score Brought to you by
  27. 27. 27 Managerial Autonomy is correlated with management practice 0.29 0.14 -0.07 -0.31 Management practice score Managerial Autonomy Top quartile3rd quartile2nd quartileBottom quartile Brought to you by
  28. 28. 28 Private hospitals tend to have higher management practice scores 2.60 2.94 PublicPrivate1 1 Private includes both for profit and not for profit organization Hospital ownership Management practice Brought to you by
  29. 29. 29 In manufacturing multinationals outperform domestic firms 3.00 3.06 3.07 3.12 3.17 3.17 3.24 3.29 3.32 3.36 3.48 2.63 2.47 2.85 2.74 2.85 3.13 2.61 3.02 2.88 2.54 3.16 China Greece France Poland UK Germany Italy India Sweden US Portugal 1 Japan excluded due to low multinational sample size Multinationals Domestic firms Management practice score – by country1 Brought to you by
  30. 30. 3030 In manufacturing, ownership matters for management and productivity Management practice score Labour productivity1 1 As measured by sales/employee 2 Government Scores: Mgmt practice 2.45, Productivity 4.3, not shown as off scale 5.0 5.1 5.2 5.3 5.4 5.5 5.6 2.5 2.7 2.9 3.1 3.3 Correlation of 0.708 Private individuals Managers Other Family CEO Founder CEO Family CEO, Primo Geniture Founder owned, external CEO US multinational Other multinational EU multinational Family owned, external CEO Dispersed shareholders Private equity/VC Government2 Brought to you by
  31. 31. Agenda An overview1 Measuring management practices in healthcare2 Describing management across hospitals3 “Drivers” of management practices4 Implications for policy makers and others5 Brought to you by
  32. 32. 32 These findings pose some questions for UK policy makers ▪How can greater competition be fostered ? ▪How can the trend to more clinically qualified managers be accelerated to close the gap with other countries ? ▪Which conditions need to be in place to give managers increased autonomy ? ▪What role could diversity of provision play in raising the bar ? ▪How could greater talent management flexibility be realistically introduced into the system ? Brought to you by
  33. 33. 33 There are also questions for other stakeholders ▪ How do commissioners ensure access to top performing hospitals? ▪ What implications, if any, are there for GP Commissioners? Commissioners ▪ How can viable investment opportunities be unlocked? ▪ What would make UK healthcare a more attractive investment?Investors ▪ What are you going to need/demand to ensure you are best informed and able to execute choice?Patients ▪ What role can AHSC’s play in developing more clinically trained and excellent managers? ▪ Are AHSC’s fully capturing the potential export opportunity? Academic Health Science Centres Brought to you by
  34. 34. Management Matters in Healthcare Brought to you by
  35. 35. 011-25464531, 011-41425180, 011-66217387 +91-9818308353,+91-9818569476 othermotherindia@gmail.com www.other-mother.in https://www.facebook.com/pages/Other-Mother-Nursing-Crusade/224235031114989?ref=hl http://www.linkedin.com/profile/view?id=326103341&trk=nav_responsive_tab_profile https://twitter.com/othermotherindi https://cparveen.wix.com/other-mother A WORLDWIDE MISSITION Contact Us:- JOIN US

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