The impact of management practices on relative patient mortality: Evidence from public hospitals

Abstract

A small, but growing, body of empirical evidence shows that the material and persistent variation in many aspects of the performance of healthcare organisations can be related to variation in their management practices. This study uses public data on hospital patient mortality outcomes, the Summary Hospital-level Mortality Indicator (SHMI) to extend this programme of research. We assemble a five-year dataset combining SHMI with potential confounding variables for all English NHS non-specialist acute hospital trusts. The large number of providers working within a common system provides a powerful environment for such investigations. We find considerable variation in SHMI between trusts and a high degree of persistence of high- or low performance. This variation is associated with a composite metric for management practices based on the NHS National Staff Survey. We then use a machine learning technique to suggest potential clusters of individual management practices related to patient mortality performance and test some of these using traditional multivariate regression. The results support the hypothesis that such clusters do matter for patient mortality, and so we conclude that any systematic effort at improving patient mortality should consider adopting an optimal cluster of management practices.

Achieving high performance in healthcare institutions: a longitudinal perspective

“…This focus has been a good choice of the institutions, because research has shown that when people get along better with each other in an organisation, that this forms the basis of successful change in that organisation [38,39]. Appendix 2 shows all three institutions have advanced on people being allowed to make mistakes (characteristic 12); being open to change (13); their managers being trusted (15), having integrity (16) and being a role model (17) and a coach to employees (20); and having a diverse workforce (29) in a secure environment (35). It seems that people in all three institutions started to spend more time together, paying more attention to each other, knowing each other's personal situation better, thus creating a safer and potentially happier workplace.…”

“…This is strange, as studies of low-performing and failing healthcare institutions revealed that the main causes for the problems are often organisational of nature: low leadership capability, leadership focused too much on avoiding penalties and achieving nancial targets, a poor and closed or even hierarchical organisational culture, lack of a cohesive mission, and dysfunctional external relationships [5,16]. Fortunately, a growing body of empirical research indicates that the performance of healthcare institutions can be related to the quality of the management practices they apply [11,17]. Recent literature indicates that effective management and organisation of resources drive higher-quality patient outcomes, and that management practices have a higher impact on performance when they are implemented in a holistic approach using speci c con gurations [17,18].…”

“…Fortunately, a growing body of empirical research indicates that the performance of healthcare institutions can be related to the quality of the management practices they apply [11,17]. Recent literature indicates that effective management and organisation of resources drive higher-quality patient outcomes, and that management practices have a higher impact on performance when they are implemented in a holistic approach using speci c con gurations [17,18].…”