Better NHS management 'leads to better outcomes'

The consultancy, with the London School of Economics centre for economic performance, has compared the quality of management at 1,194 hospitals internationally, including 180 in the UK, through detailed interviews with middle-level managers.

Researchers found the link was so strong in the UK that a one point increase on their management practice indicator (which has a range of zero to five) was associated with a 6.5 per cent reduction in the risk adjusted 30 day death rate after heart attack.

The one point increase was also related to a 33 per cent increase in income per bed – a measure of efficiency – and a 20 per cent increase in the probability the hospital had above average patient satisfaction.

Stephen Dorgan, a McKinsey partner, said: “We can’t prove causality, but I find it difficult to believe hospitals where mortality rates are lower just happen to have better management practice. There is an intuitive link.”

The researchers said it was “surprising” the UK had high management score compared to other countries – second only to the US and Sweden – despite spending less per head on healthcare than most countries.

The relatively high quality of NHS management is also surprising given there is much less clinical management in UK hospitals than elsewhere. In the UK 57.9 per cent of managers have a clinical degree – compared to 93.4 per cent in Sweden and 74.1 per cent in the US.

The researchers said improving the proportion of clinical managers could rapidly improve management and outcomes.

They also recommended increasing competition between hospitals. Although that was present in some areas of the UK like London it was not in rural areas, and could be achieved by publishing more comparative information.

The authors said larger hospital trusts were better managed, suggesting consolidation should be encouraged. Hospitals with more autonomous systems – such as service line management were also performed better.

They said private hospitals were better managed which suggested more independent providers should be encouraged in the UK.