Hospitals less likely to shut in marginal seats


Hospitals less likely to shut in marginal seats
Hospitals less likely to shut in marginal seats | Society | The Observer
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Hospitals less likely to shut in marginal
Closures take place in safe constituencies because there is less
fear of a voter backlash
Anushka Asthana and Denis Campbell
The Observer, Sunday 14 February 2010
larger | smaller
Hospitals located in safe parliamentary seats where political competition is weak are
much more likely to be closed than those in marginal constituencies, new research
The study, by academics at the London School of Economics, illustrates just how
damaging shutting hospitals can be, with the authorities seemingly shying away from
closures in politically sensitive areas. The report also reveals how much of a difference
good management can make to the way in which hospitals operate. It finds that:
■ A slight improvement in the way in which a hospital is managed can result in up to
400 fewer deaths each year.
■ Hospitals are best managed when doctors and nurses are employed in senior
management positions.
■ Those that perform best are in areas with a higher number of hospitals nearby,
increasing competition.
Professor John Van Reenen, director of the Centre for Economic Performance at the
LSE and co-author of the report, said he wanted to find out why hospital performance
varied so much around the country. The academic said the study, which looked at 100
English hospitals and will be published this week in the journal Centrepiece, found that
patients taken to well-managed hospitals after a heart attack were significantly more
likely to survive.
He said it made sense that hospitals did well when people with clinical experience were
in charge, because they could communicate in a language that "doctors and nurses
In terms of closures, he added: "We found that in marginal constituencies hospitals are
much less likely to be closed down. So there are far more hospitals in politically
marginal wards." The reason, he added, was because health was the top priority for most
people. "It is what people care about. What people really want to know is whether they
will be looked after if they become unwell, and whether their relatives will be cared for."
He highlighted the case of Richard Taylor, a doctor whose campaign to keep
Kidderminster hospital open resulted in him unseating a Labour minister in Wyre
Forest in 2001. He then held on to the seat in 2005.
Taylor said there was always a "political element" when NHS services were reconfigured
and decisions were made around units closing down. But he argued the key issue was
whether there were alternative medical services nearby.
The MP refuted the notion that more competition improved hospital performance and
said he was ardently against the market. "Since the instigation of the internal market in
the NHS, and the purchaser-provider split and thus of competition, the numbers of
management personnel have gone up sharply, sometimes by as much as tenfold."
Dr John Lister of Health Emergency, which campaigns against private-sector
Hospitals less likely to shut in marginal seats | Society | The Observer
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involvement in the NHS, agreed, arguing that co-operation rather than competition led
to better health outcomes. "Under competition a few strong hospitals do better than
others, but how do you then raise the standards of the others?"
David Furness, head of strategic development at the Social Market Foundation, said that
the NHS was about far more than just hospitals and that protecting health services
should be about "values not buildings".
"We need fewer hospital beds. People are treated more rapidly than ever before," he
said. "But fewer beds mean fewer hospitals. And politicians will not accept the inevitable
political pain of hospital closures. With the crisis in public finances threatening the
future of the health service, this fixation with protecting hospitals from closure might tip
the NHS over the edge." © Guardian News and Media Limited 2010
Hospitals more likely to close in safe seats - Telegraph
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Hospitals more likely to close in safe seats
Hospitals in safe parliamentary seats are much more likely to be closed than those in
marginal constituencies where politicians fear a backlash from voters, a study has found.
By Heidi Blake
Published: 7:30AM GMT 15 Feb 2010
The report by academics at the London School of Economics (LSE) shows that there is a far higher
concentration of hospitals in politically sensitive areas “where no one wants to be blamed for hospital closure”
than in areas where the Government enjoys a comfortable majority.
Patients receive significantly better care in areas with a greater number of hospitals, because competition
drives medical staff to do a better job, the report said.
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It also showed that private hospitals are better managed than those run by the NHS, and disclosed the
devastating consequences that poor management can have for patients.
Around 400 deaths could be prevented every year from heart attacks alone if hospitals made a tiny
improvement in the way they were managed, the study from LSE’s Centre for Economic Performance (CEP)
In one badly-run hospital, a manager admitted that able-bodied patients had been forced to help push the
sicker patients around in their beds because of staff shortages.
Professor John Van Reenen, director of the CEP and co-author of the report, said the findings showed how
patients in safe parliamentary seats, where competition among hospitals is low, can suffer.
“What we have found is that if you’re in a marginal seat you have a lot more hospitals, but if you’re in a safe
seat your local hospitals are much more likely to close,” he said.
“It’s hard for any Government to close down a hospital because the public will not like it, and because of that
politicians are less likely to close down a hospital in an area that’s more politically contestable.”
The reason for the disparity was that health was a top priority for most voters, Prof Van Reenen said.
"It is what people care about. What people really want to know is whether they will be looked after if they
become unwell, and whether their relatives will be cared for.”
The study, which looked at 100 hospitals, disclosed that patients taken to well managed hospitals after a heart
attack were significantly more likely to survive. 05/03/2010
Hospitals more likely to close in safe seats - Telegraph
Page 2 of 2
It found that management scores in NHS hospitals were generally lower than in the private sector, including in
the manufacturing and retail industries as well as in private hospitals.
Hospitals managed by executives with no clinical experience perform worse than those where doctors and
nurses are promoted to senior management positions, according to the report, which will be published this
week in the journal Centrepiece.
“People management” was particularly bad in the NHS, the report said.
In one institution, an NHS manager who was asked whether staff often ended up doing the wrong sort of work
for their skill level said: “You mean like doctors doing nurses’ jobs and nurses doing porter jobs? Yeah, all the
time. Last week, we had to get the healthier patients to push around the beds for the sicker patients.”
Prof Van Reenen highlighted the case of Richard Taylor, a doctor whose campaign to keep Kidderminster
hospital open resulted in him unseating a Labour minister in Wyre Forest in 2001, as evidence that local
hospitals are highly charged politically.
© Copyright of Telegraph Media Group Limited 2010 05/03/2010
BBC News
Douglas Fraser’s Ledger
Tuesday 16 February, 2010
Hospital pass
While Conservatives are suggesting hospitals and other public services could be run by
co-operatives, we've got new evidence of the difference a good management makes.
The Centre for Economic Performance has just published research showing that hospital
services tend to be better when managers have some clinical experience.
They also found hospitals have better management where there are a larger number of
competing hospitals nearby - though couldn't that be a factor of being in a larger
population centre, with more patient throughput?
However, really, truly amazing is the finding that hospitals in marginal constituencies are
"much less likely to be closed" than those in safe seats.
Who'd have thunk it? print article
Page 1 of 1
Competition good for hospitals, study says
By Nicholas Timmins, Public Policy Editor
Published: February 18 2010 23:13 | Last updated: February 18 2010 23:13
Competition produces better managed hospitals which, in turn, produce better outcomes for patients, according to
new research from the Centre for Economic Performance at the London School of Economics.
With the role of choice and competition in the National Health Service still highly controversial – the British Medical
Association is currently running a large campaign against the commercialisation of the NHS – the research
provides “clear cut evidence that competition between hospitals produces benefits,” Carol Propper, one of the
study’s authors, said.
The study interviewed managers and clinicians at 100 big NHS hospitals, using a mildly adapted version of a
standard measure of management performance that is widely used to assess private sector companies.
It compared the quality of management with a small range of clinical outcomes – such as deaths from heart
attacks and emergency surgery, or hospital-acquired infections – and the scores given to hospitals for quality of
care and financial management by the NHS inspectorate, the Care Quality Commission. It then looked at how
many local rivals the hospitals had.
The conclusion, Professor Propper said, is that “better management produces better hospitals and competition
between hospitals produces better management”.
Hospitals “with higher management scores have better clinical outcomes, shorter waiting times, better financial
performance and higher staff satisfaction,” the study concludes.
Management was better where senior managers have some clinical training – a finding that reinforces repeated
government attempts over recent decades to involve clinicians more in management. But it also concludes that
“competition has a large effect in improving managerial quality in hospitals”.
How it does so remains open to question, the study says. It may be that the market reforms in the NHS, with
money attached to each treatment, mean “hospitals now have an incentive to provide better care to attract
In areas with a relatively large number of competitors, it may be easier to assess performance by comparison with
neighbours. Or it may be that a competitive environment provides an attractive market for good managers. “With
more hospitals nearby, it is easier for managers to look out for better employment opportunities”.
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Health Investor
Monday 22 February, 2010
Competition in the NHS has improved services
Hospitals and their patients have benefited from exposure to competition, according to new
research by the Centre for Economic Performance at the London School of Economics.
The report counters some of the claims raised by the British Medical Associations campaign
against the role of the market in the health service.
Competition between hospitals to deliver services has produced “clear cut evidence that
competition between hospitals produces benefits,” said Carol Popper, one of the study’s
By measuring hospital performance using adapted metrics used for private sector companies
the authors said “better management procedures produces better hospitals and competition
between hospitals produces better management”.
¿Por qué algunas empresas están mejor gestionadas? - Imprimir - Libertad Digital
Page 1 of 3
¿Por qué algunas empresas están
mejor gestionadas?
Un nuevo estudio analiza por qué las prácticas de gestión difieren entre empresas y países. Su
conclusión es que una combinación de mercados imperfectamente competitivos, empresas
familiares, regulaciones administrativas y barreras informacionales explica la persistencia de la
mala gestión.
La productividad varía mucho entre empresas y países. Esta divergencia no puede explicarse recurriendo
únicamente a la productividad de distintos factores, como el capital intensivo. Un estudio concluyó que
sólo la mitad del diferencial de su muestra era función del empleo de distintos factores. Otro trabajo
encontró marcadas diferencias de productividad, incluso, dentro de industrias de bienes muy homogéneos,
como las cajas y los bloques de hielo.
Desde hace décadas ha sido difícil para los economistas atribuir el diferencial entre empresas o países
(una vez calculada la contribución de los distintos factores) a causas concretas. “La medida de nuestra
ignorancia” es como llamaba el economista Moses Abramobitz a la productividad de un país. Una posible
explicación es el uso de innovaciones tecnológicas como nueva maquinaria o patentes, pero incluso
controlando estos factores sigue habiendo importantes diferencias.
Nicholas Bloom y John Van Reenen aportan una nueva hipótesis en Why Do Management Practices
Differ across Firms and Countries?, publicado en el Journal of Economic Perspectives. Según estos autores,
las distintas prácticas de gestión de las empresas explican parte de ese diferencial, y el estudio presenta
evidencias a favor de esta tesis.
La literatura sobre gestión, afirman Bloom y Van Reenen, suele basarse en casos de estudio más que en
datos empíricos sistemáticos de empresas y países. Los autores han conducido un conjunto de encuestas
durante la pasada década, centrándose en aspectos relevantes de la gestión como la supervisión del
comportamiento de los empleados, el establecimiento de los objetivos adecuados o los esquemas de
incentivos para promover el buen rendimiento.
Tradicionalmente, los economistas han rechazado la hipótesis de Bloom y Van Reenen considerando que
es relativamente sencillo y rápido cambiar el modelo de gestión si con ello se consiguen importantes
mejoras de productividad. ¿Qué barreras lo impiden? Los autores del estudio sostienen, no obstante,
que las diferencias en la gestión están a menudo enraizadas en diferencias más profundas de información,
sociales, legales y tecnológicas.
Bloom y Van Reenan destacan diez conclusiones en su estudio:
1. Las empresas con mejores prácticas tienden a ser mejores en un conjunto de variables: son más
grandes, más productivas, crecen más rápido, y tienen una tasa de supervivencia más alta.
2. Las prácticas de gestión divergen mucho entre empresas y países. La mayor parte del diferencial de la
gestión media en cada país es función de la cola de empresas mal gestionadas, más larga en unos que en
otros. Por ejemplo, pocas compañías están muy mal gestionadas en Estados Unidos, mientras que
en Brasil e India hay muchas empresas en esta categoría.
¿Por qué algunas empresas están mejor gestionadas? - Imprimir - Libertad Digital
Page 2 of 3
3. Los países y las compañías se especializan en distintos estilos de gestión. Por ejemplo, las empresas
americanas puntúan mejor que las suecas en incentivos, pero peor en control del personal.
4. Una fuerte competencia en el mercado tiende a mejorar el nivel medio de la gestión, acortando la
cola de empresas muy mal gestionadas y presionando a las recién llegadas a adoptar mejores prácticas.
5. Las multinacionales están generalmente bien gestionadas en cualquier país. También suelen
trasplantar sus estilos de gestión a sus filiales. Por ejemplo, multinacionales americanas en el Reino Unido
son mejores en incentivos y peor en control de los empleados que las multinacionales suecas en el Reino
6. Las empresas que exportan al extranjero (pero no producen fuera del país) están mejor gestionadas
que las empresas no-exportadores, pero peor gestionadas que las multinacionales.
7. Las empresas de propiedad familiar que sitúan a un miembro de la familia (normalmente el hijo
mayor) en la dirección están de media muy mal gestionadas.
8. Las empresas estatales están en general extremadamente mal gestionadas. Empresas en bolsa o
privadas suelen estar bien gestionadas.
9. Las compañías que utilizan capital humano más intensamente, medido por el número de
trabajadores educados, tienden a tener prácticas de gestión mejores.
10. A nivel de los países, un mercado laboral flexible está asociado a mejores incentivos por parte de la
¿Por qué algunas empresas están mejor gestionadas? - Imprimir - Libertad Digital
Page 3 of 3
© Libertad Digital SA Juan Esplandiu 13 - 28007 Madrid
Printer Friendly
Page 1 of 2
From The Times
February 26, 2010
Researchers point finger at doctors over
manipulating figures
Carol Lewis
General practitioners have been accused of manipulation to achieve additional payments under the
NHS’s quality and outcomes framework (QoF).
Under the framework, GPs’ pay has increased and working hours have decreased, while the effect on
patient care is unquantifiable, according to research by Hugh Gravelle, a health economist at the
University of York, and colleagues from the University of Aberdeen.
The framework, which was introduced in April 2004, links treatment for a range of conditions such as
heart disease, epilepsy and diabetes to GP pay. However, Professor Gravelle’s damning research
paper Doctor Behaviour Under a Pay for Performance Contract: Treating, Cheating and Case Finding?
found that it is difficult to measure the effect that the framework has had on the quality of patient care. It
points out that the NHS neither routinely collected data on the incentivised activities before its
introduction, nor was the scheme given a trial before being adopted nationwide.
According to Professor Gravelle: “Pilot schemes with baseline measurements would have revealed if
quality was already improving and may have enabled the taxpayer to get better value for money from
the scheme.”
Yet the framework was welcomed by GPs. Practices received considerable increases in gross income
— £1,000 million in payments a year. At the same time, GPs’ normal working hours and job pressure
fell sharply. Not surprisingly, their job satisfaction increased. The QoF was “a very good deal for GPs”,
Professor Gravelle said.
The indicators in the scheme are presented as a ratio of the number of patients treated against the
number of patients eligible for treatment. However, patients can be exempt for a number of reasons
including being terminally ill, frail, newly diagnosed, intolerant to treatment or failing to turn up to
The research, published in the February edition of the Economic Journal, says that some practices
deliberately increased the number of exception reports to increase their indicator scores and, therefore,
? The hospitals with the best managers deliver the best patient care, according to researchers at the
Centre for Economic Performance. Hospitals which took people management, monitoring and targetsetting seriously had the best clinical outcomes, shorter waiting times, better financial performance and
higher staff satisfaction than those that didn’t.
For example, a small (one deviation point) improvement in management scores could mean a fall in
deaths from heart attacks from 17 per cent to 16 per cent — or 400 fewer deaths. Management was
best in those hospitals where managers had some clinical training and in hospitals with a lot of
competing hospitals near by.
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Empresas do Brasil são mal geridas, diz estudo - Pós-Graduação - Gazeta do Povo
Page 1 of 1
Sexta-feira, 05/03/2010
Empresas do Brasil são mal geridas, diz estudo
Pesquisa coloca as companhias brasileiras na 14.ª colocação em ranking das melhores práticas de gestão
03/03/2010 | 00:20 | BRENO BALDRATI
Numa lista de 17 países com as empresas mais bem administradas, o Brasil está na rabeira. Na média, as companhias brasileiras têm melhores práticas de
gestão apenas do que as da China, Índia e Grécia. Estados Unidos, Alemanha e Suécia estão no topo do ranking. Esse é o resultado de um estudo publicado
no mês passado no Journal of Economic Perspectives, realizado pelos economistas Nicholas Bloom, da Stanford University, e John Van Reenen, da London
School of Economics.
Para mensurar as práticas de gestão, os dois professores realizaram entrevistas em empresas de tamanho médio, com 100 a 5 mil funcionários, escolhidas
aleatoriamente. No Brasil, foram 559 firmas pesquisadas. A partir das respostas, eles definiram uma pontuação de 1 (pior prática) a 5 (melhor prática) para
18 práticas básicas de gestão. De maneira geral, essas 18 categorias podem ser divididas em três grandes grupos: monitoramento, metas e incentivos (saiba
mais no gráfico). Segundo os autores, uma pontuação elevada mostra que a empresa é mais bem administrada e, na média, também mais produtiva. As
empresas brasileiras obtiveram nota média 2,69. Os EUA receberam 3,33.
A categoria em que o Brasil se saiu pior foi em incentivos – a capacidade de promover e contratar funcionários. Em parte, a resposta para isso está na
legislação trabalhista do país, pouco flexível. O uso do capital humano, medido por trabalhadores mais educados, também afeta o desempenho brasileiro.
Quanto maior o grau de escolaridade dos gerentes e dos funcionários, em geral também maior a nota que a empresa recebe. “Nossa crença é de que mais
educação empresarial básica – por exemplo, sobre questões de orçamento, análise de dados e práticas de recursos humanos – poderia ajudar a melhorar a
gestão em muitos países, especialmente nos em desenvolvimento”, afirma os autores.
Outro problema brasileiro foi o tamanho da “cauda longa” – o grande volume de empresas muito mal gerenciadas. Brasil e Índia têm um número razoável de
empresas bem administradas, especialmente multinacionais e exportadoras, duas condições diretamente ligadas a uma boa nota, mas tiveram a média
puxada para baixo pelo grande número de empresas muito mal administradas.
Esse mal gerenciamento está relacionado a uma série de fatores, entre eles a quem é o proprietário da firma. As empresas familiares que nomeiam um
membro da família (especialmente o filho mais velho) como o CEO e as empresas do governo, por exemplo, formam o grupo com a piores notas. Esse fato
complicou a situação brasileira. Enquanto nos países ricos – Alemanha, Japão, Suécia e Estados Unidos – o número de empresas desse grupo representa 20
% a 30% da amostra; para Brasil, Portugal, Itália e Grécia ele equivale a 60%. “Uma explicação para essa diferença é que o subdesenvolvimento do mercado
financeiro e a fraqueza da força da lei em muitos dos países em desenvolvimento torna extremamente difícil a separação entre propriedade e controle. Por
exemplo, famílias podem ficar relutantes em contratar gerentes de fora porque a lei não é forte o suficiente para protegê-las em casos de roubo”, escrevem
os autores. As empresas com os preços das ações cotadas em bolsa ou de propriedade de firmas de private equity foram as que foram mais bem avaliadas.
Segundo o estudo, as empresas que enfrentam mais concorrência em geral receberam as melhores notas. Quando a competição no mercado de um
determinado produto não é intensa, argumentam os autores, uma empresa com pouca produtividade (e mal administrada) é capaz de permanecer no
FECHAR 05/03/2010
Measuring management practices | vox - Research-based policy analysis and comment... Page 1 of 1
Research-based policy analysis and commentary from leading economists
Measuring management practices
John Van Reenen
Interviewed by Romesh Vaitilingam
5 March 2010
How important are management practices in driving the performance of
firms and the productivity of nations across Asia, Europe and North
America? John Van Reenen, director of the Centre for Economic
Performance (CEP) at the London School of Economics, talks to Romesh
Vaitilingam about CEP’s research programme on the economics of
management and productivity. The interview was recorded in London in
February 2010.
(22 minutes 38 seconds)
Related research here.
(MP3 file 10.3MB)
Related article(s):
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Topics: Competition policy, Industrial organisation, Productivity and