Published: 03/06/2004, Volume II4, No. 5908 Page 3

Managers have been urged to 'squeeze more activity' out of their clinicians following a report on variations in clinical productivity.

'We need to challenge doctors and we should be much more collaborative with doctors to use data to improve activity, ' Professor Alan Maynard, one of the contributors to the NHS Confederation report, told HSJ.

'Doctors are managed to hit gross activity targets, herded to hit the nine-month waits and outpatient targets, but not micro-managed, ' he said.

Managers already had access to a rich data set that could flag up variations, Professor Maynard added.

And he accused managers of failing to make the best use of hospital episodes statistics, which have been available for nearly two decades.

'This is not rocket science, It is bloody obvious, ' said Professor Maynard, director of the health policy group at York University.

Hospital managers haven't looked at the data and they haven't managed the data. Neither have clinicians. There is the data, go out and use it.'

The confederation's seminar report says trust boards and clinical leaders need to start asking tougher questions about variations in results, and the differences between organisations.

It also calls on managers to pay more attention to efficiency in clinical services, where the vast majority of NHS money is spent.

To make real improvements in efficiency and outcomes, 'we should go looking for where the money is', commented confederation policy director Nigel Edwards.

The report highlights a number of examples of significant variations in the productivity of clinicians, teams and organisations.

These include:

nthe staffing ratio in A&E departments varies from one nurse per 1,000 patients in some trusts to one per 2,000 in others;

some accident and emergency departments have one doctor per 2,500 patients while at the other end of the scale the ratio is one per 6,000;

nin different outpatient clinics, there is a fivefold variation in doctors'workloads.

Some amount of variation is understandable and at times even desirable, the report says. It might be unwise to ask a slow surgeon to simply operate faster.

But Professor Maynard said it should be possible to explicitly define an acceptable level of variation. Warning that managers and clinicians still lacked incentives to improve efficiency, he suggested that actions to address clinical variation could be examined in annual appraisals for trust chief executives and chairs, and that consultants might be better motivated by a fee-for-service arrangement.

The report also says that clinical variation could be improved by adopting standardised care pathways for high-volume cases and chronic diseases.

'Looking at pathways is nonjudgemental and It is a way of talking to clinicians about things they're interested in, ' said Mr Edwards. 'If you talk about improvements in outcomes they are more likely to want to have a conversation.'