The appliance of science

If doctors have to prove that their treatments work, should healthcare managers be far behind? No, says Professor Per-Gunnar Svensson, director general of the International Hospital Federation, who argues that managers should stop following the latest fad, and start approaching their jobs in a scientific way.

There should be a critical assessment of clinical practice and management as part of hospitals opening up to the public, he told the European Healthcare Management Association's conference in Dublin last week.

'A sound evidence-based management system should be established upon review, as is the case with evidence-based medicine,' he said.

The criteria for measuring evidence-based management might differ from those applied to evidence -based medicine, but it was time to get away from simply reflecting the latest fashion in management.

He illustrated his point with a cartoon advising a new manager: 'You will appear to be a visionary planner if you decentralise

everything that is centralised, and centralise everything that is decentralised.'

Change for its own sake was pointless, Professor Svensson argued. But there was no one blueprint or policy model, and each country should develop its own model based on its history, values and financial constraints.

Delegates, lured in greater numbers than ever to the conference, objected that there was precious little evidence of what kind of management worked in health services.

But Professor Svensson told HSJ that management should be looked into in the same way as medicine, by testing and evaluating successes and failures so that proven good management could be introduced more widely.

It should be debated, he said, even if, at the end of the day, healthcare managers had to accept government decisions on policy - for example, on the priority given to waiting lists.

'But it should be argued first. At least the present government says it wants open debate and discussion before it takes decisions.'

Unfortunately, managers felt that there was a gap between rhetoric and reality, according to a survey by Manchester health authority chief executive Neil Goodwin, which was presented at a conference workshop.

He said the government was in a hurry to get to grips with the NHS and was setting deadlines that left no room for local negotiations, particularly over short-term issues such as waiting lists.

Research had already shown a lack of innovation among health service managers, who were defensive because of the political climate in which they operated, he told delegates.

Similar findings emerged from his survey of 11 HA chief executives - one in 10 of the English total - and how they saw their leadership roles in the health service's new climate.

Most saw central government policies and targets as the main drivers of strategic change in the health service, with HA policies and scientific developments much less influential. Trusts, GPs and local politicians were rated almost nowhere in driving change.

HA chief executives thought the overall direction of government policy was too detailed and specific, and wanted more freedom to interpret it locally. But they were happy with the tight timescales.

And, despite acknowledging the primary influence of government policy, they strongly agreed with the idea that HAs had a major role in providing leadership of local healthcare systems.

Mr Goodwin said the survey showed that HA chief executives in their present role, which excluded directly managing health services, were not 'true' or 'complete' leaders.

'We don't specify the strategy or the vision. We focus on the implementation end of the leadership spectrum. We are driven by politics. The success of the HA chief executive depends on inter-organisational collaboration, which will increase in future,' he said.

The health agenda may be driving managers at all levels to seek alliances and networks, but there were barriers in the way, according to Professor Sandra Dawson, director of the Judge Institute at Cambridge University.

There were good reasons for change, including the fact that there was never enough money, people's expectations increased, and there were more and different things to be done to improve health, she told the conference.

But the different worlds inhabited by potential networkers made alliances difficult to achieve.

Instead of accepting the 'fearful ignorance' and blank walls that often met attempts to form new alliances, managers should create better networks and alliances in healthcare, she said.

This was just the sort of stuff EHMA director Philip Berman was looking for when he started organising the conference.

Healthcare in Europe was in a post-Thatcherite mood, he said. It was a change from the stark era of competition into one with a more collaborative approach.

Even if, as Professor Dawson put it, the initial response to efforts to set up new networks often ranged from 'it wasn't invented here' and 'we're superior' to 'we don't need you' and 'we have nothing in common'.