The Reluctant Managers: Clinicians and Budgets in the NHS

Pollitt, Christopher; Harrison, Steve; Hunter, David J.; Marnoch, Gordon

doi:10.1111/j.1468-0408.1988.tb00299.x

Cited by 44 publications

(34 citation statements)

References 13 publications

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“…This is the view of the government's own review of MB (DHSS, 1986) and of academic studies of the effectiveness of this initiative (Pollitt et al, 1988;Preston et al, 1992). In addressing research Q2 and Q3, respectively, the studies of MB clearly indicate that it failed to penetrate the medical core of hospitals and hospital doctors had not acted on this information.…”

Section: The Management Budgeting Initiativementioning

confidence: 93%

“…In England, studies by Pollitt et al (1988); Preston et al (1992) on the first initiative Management Budgeting (DoH, 1985) indicated a rejection by hospital doctors of the principle of clinical budgeting. Packwood et al (1991) detail an investigation of a subsequent initiative in England Resource Management (DHSS, 1986) in which there was little evidence of operational versions of such clinical budgeting systems and agnosticism on the part of hospital doctors on potential benefits for patient care-their major concern.…”

Section: The Accounting-clinical Interfacementioning

confidence: 98%

“…It confirms the findings of the studies in England. Pollitt et al (1988) was essentially an examination of the introduction of general management in the NHS in England. This entailed extensive interviews over a period contemporaneous with this article's study of MB in Scotland (1987/88) with senior managers and hospital doctors.…”

Section: The Management Budgeting Initiativementioning

confidence: 99%

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The Accounting–Clinical Interface—Implementing Budgets for Hospital Doctors

Lapsley

2001

Abacus

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The implementation of budgets for hospital doctors has been the subject of study in many countries. A general conclusion to emerge from these various studies is that of failure-of an inability of accounting information to make meaningful connections with the world of the hospital doctors. A distinguishing feature of many policy initiatives which seek to reform practice in the state-owned or state-financed institutions has been the perspective adopted by policy-makers-that of modernizers or reformers who pursue their policies with relentless conviction, even where there is no sign of successful implementation. This article presents a contrasting view, in which a more complex understanding of the reform process is necessary, to explain successful clinical budgeting.

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Section: The Management Budgeting Initiativementioning

confidence: 93%

Section: The Accounting-clinical Interfacementioning

confidence: 98%

Section: The Management Budgeting Initiativementioning

confidence: 99%

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The Accounting–Clinical Interface—Implementing Budgets for Hospital Doctors

Lapsley

2001

Abacus

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“…Whether in healthcare or elsewhere, professionals have resisted these reforms on the grounds that they seek to supplant a professional logic with an administrative-managerial logic (Blomgren 2003). In the field of healthcare, clinicians have been viewed as seeking to preserve intact the boundaries of the medical enclosure (Pollitt et al 1988, Rose and Miller 1992, Jones and Dewing 1997. Despite repeated attempts, and over several decades, to involve UK clinicians in budgeting, costing and cost management exercises, this reluctance on the part of clinicians to actively participate in the hybridizing of medical and financial expertise persists, at least within some quarters of the medical profession.…”

Section: Counting the Costs 13mentioning

confidence: 98%

Counting the costs: The risks of regulating and accounting for health care provision

Kurunmäki¹,

Miller²

2008

Health, Risk & Society

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Payment by Results (PbR) is one of the most fundamental changes in NHS policy since the introduction of the 'internal market' in 1991. It is also one of the most visible and influential attempts across the same period to modernize the NHS through accounting and, more specifically, costing. As a funding system, PbR promises to pay providers fairly and transparently by using a 'standard national tariff.' However, like all accounting based reforms, PbR encounters the range of professions and expertises active in the domain. Like all costing systems that give visibility where previously it was lacking, PbR creates new calculable spaces and new risks. The aim of the paper is threefold. First, we seek to chart the nature of the arena within which PbR operates. We identify the multiple actors that are influential in the regulatory field of health service provision, and focus on three types of actor in particular, namely the National Institute for Health and Clinical Excellence (NICE), Monitor and professional medical associations. We argue that these three actors need to be viewed as representative of different types of expertise (schematically speaking, health economics, accounting and medicine) and that, to understand fully the nature of the regulatory game in the healthcare arena, PbR needs to be analysed not as a stand alone intervention but as enmeshed within the inter-professional complex that emerges out of the interaction of these three types of expertise. Second, we argue that we need to focus on the ways in which PbR, along with other regulatory interventions in the healthcare field, such as those of NICE and Monitor, seek to create new and sometimes competing calculable spaces based on different entity assumptions. Third, we argue that to understand empirically the dynamics of healthcare reform in the UK we need to examine the extent to which PbR creates new calculating selves, or a hybridizing of the calculating and medical self. The regulatory complex within which PbR operates may, we argue, produce contradictory incentives and thereby contribute to systemic provision risks.

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“…They and other staff members may resent decentralization, if it seems to be aimed solely at reducing expenditure. It has been shown that, although they are sensitive to the need to economize, physicians are reluctant to co-operate with cost-containment programmes [27]. Financial considerations may even be perceived as contradicting the medical ethos [28].…”

Section: Job Design and Staff Moralementioning

confidence: 98%

Clinic Decentralization: An Israeli Model and Evaluation Strategy

Gross

Elhayany²,

Zmora³

1993

Journal of Management in Medicine

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KHC is Israel's dominant provider and insurer of primary care services. It operates about 1,300 clinics and employs over 2,300 primary care physicians. KHC also owns eight acute-care hospitals, three psychiatric hospitals and three geriatric hospitals. Approximately 75 per cent of Israel's population are insured through KHC, another 20 per cent through three smaller health insurance funds, while 5 per cent of the population is uninsured [6].At present, KHC has a centralized organizational structure: central management defines overall policy, allocates itemized budgets to its 14 districts and 14 hospitals, and supervises their activities. Each district has a district management responsible for the district's budget and for supervising its community clinics, specialty clinics, laboratories and diagnostic centres. District management is responsible for determining the drugs which physicians can prescribe, the hospitals and diagnostic centres to which they can refer patients, and clinic operating policy.The community clinics are staffed by physicians, nurses, administrators, pharmacists and, in some cases, specialists. Some clinics also operate a laboratory. The clinic itself is managed by a team comprising a physician, a nurse and an administrator. The clinics provide services, but have little autonomy. They do not determine staff employment, operating hours or the scope of services offered by the clinic, nor do they have any fiscal responsibility.Over the years, KHC' s deficit has grown and its membership has declined[7]. KHC' s decentralization programme is, in part, a response to mounting difficulties in containing costs, and increasing competition from other health insurance funds.The main objectives of decentralizing KHC clinics in the Negev district are to:(1) improve services, with the aim of increasing client satisfaction and attracting more members; (2) make more efficient use of existing resources by introducing budgetary responsibility at the clinic and physician levels; and (3) upgrade the functioning of clinic staff by increasing individual motivation, responsibility and initiative, and by improving morale.

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The Reluctant Managers: Clinicians and Budgets in the NHS

Cited by 44 publications

References 13 publications

The Accounting–Clinical Interface—Implementing Budgets for Hospital Doctors

The Accounting–Clinical Interface—Implementing Budgets for Hospital Doctors

Counting the costs: The risks of regulating and accounting for health care provision

Clinic Decentralization: An Israeli Model and Evaluation Strategy

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