This is a fascinating insight – the best-performing NHS trusts are the ones with more managers. That will annoy both the Tory types for whom the only people who exist in the NHS are doctors, and the Chris Dillow caucus left-libertarians who hate managers. But wait one. The researchers defined a manager as someone with decision-making power! Anarcho-syndicalism rules, OK.
Or not. Delegating more decisions might be a sign of better management, or perhaps the result of decisions based on better data analysis. Here’s a really good post from a great blog (a little more is here). Even Chris might get there.
Yes, as you say, it depends on how you define ‘manager’ but could it also be because more managers know how to game the measurements that make the best performing trust? This will be nothing to do, I am sure, about a good patient experience.
Great informative and interesting blog you have BTW, thanks.
This is very important.
I spent a few years on NHS mgmt, part doing, part action research.
All the international comparisons we did suggested that large parts of the service were *undermanaged.* Now as you note, that doesn’t have to mean “more managers” (Denmark for example puts a lot more management functions into nursing) but until we accept that looking after ppl is a large scale enterprise and needs coordination capacity we’re going to keep failing to achieve what we could.
Worry a little that Mr Black doesn’t understand the role of sleep rhythms in illness. There are actual longstanding reasons why discharge rounds/procedures don’t start too early – most of the lessons were learned the hard way in military hospitals (who had a lot of incentives to try different timings as conflicts created different flows of patients.)
As ever, the attempt to duck out of the reality that we need excess capacity to manage bumps of demand is the biggest failing in data-driven system management.
(Which is not to say you couldn’t get some useful improvements in improving flow by doing what can be done to line up discharges with the pattern of A&E inflow, but let’s be careful with the “can solve it all with no extra-funding claims…”)