Comparing NHS Hospital Unit Costs

Dawson, Diane; Street, Andrew

doi:10.1111/1467-9302.00237

Cited by 4 publications

(4 citation statements)

References 3 publications

(4 reference statements)

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“…Performance based budgeting is a third example of the use of performance information (Kravchuk and Schack, 1996;Lee and Burns, 2000;and Melkers and Willoughby, 1998). In other cases, attempts are made to increase market-like pressures through rankings of organisations -the so-called league tables (Gormley and Weimer, 1999;Dawson and Street, 2000;and Wiggins and Tymms, 2002). Often negative effects arise from this use of performance information.…”

Section: What Is Performance Measurement (In This Study)?mentioning

confidence: 99%

What Makes Organisations Measure? Hypotheses on the Causes and Conditions for Performance Measurement

Dooren

2005

Financ Acc Manag

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Public sector reforms regularly include a performance measurement dimension (Pollitt and Bouckaert, 2004). In doing so, performance measurement and the supply of performance information are taken for granted. Availability of performance measurement -the fundament of most New Public Management (NPM) reforms -is assumed, and reforms are built on this unsteady foundation. How realistic is this? In fact, performance measurement is a complex process that requires attention in its own right. A performance measurement policy is needed before a performance management policy may be set up.A good insight in the organisational characteristics that foster performance measurement is crucial in order to set up a performance measurement policy. Therefore, a theory of the factors that make organisations measure is needed. In this study, performance measurement is the dependent variable. Six hypotheses on why organisations measure are tested, based on a survey within the Ministry of the Flemish Community, Belgium. Organisational characteristics are related to the adoption and implementation of performance measurement.The article is structured along the variables and the hypotheses. Most of the theory therefore, is embedded in the discussion of the hypotheses. The first paragraph is a description of performance measurement. Performance measurement is a fuzzy concept, with different people adhering substantially different meanings to it. This section shows how the subject is dealt with in this article. Next, we shortly describe the methodology of the survey. Thirdly, the dependent variables are presented. The dependent variables are performance measurement adoption and performance measurement implementation. Fourthly, by bringing in the independent variables six hypotheses may be put. Finally, there is a conclusion with some implications for practice and theory.

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Section: What Is Performance Measurement (In This Study)?mentioning

confidence: 99%

What Makes Organisations Measure? Hypotheses on the Causes and Conditions for Performance Measurement

Dooren

2005

Financ Acc Manag

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“…Although the availability of comparative cost information made cost indicators the easiest route for introducing NHS benchmarking (Jones, 2002), it has been widely cautioned that costs must be interpreted within a broader framework that incorporates quality of care and other performance data (Söderlund and van der Merwe, 1999;Dawson and Street, 2000;Jones, 2002).…”

Section: Bij 125mentioning

confidence: 99%

Benchmarking in UK health: a gap between policy and practice?

Northcott

Llewellyn

2005

Benchmarking

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If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. AbstractPurpose -This paper aims to bring greater clarity to the debate on the merits (or demerits) of relative performance evaluation through a broad assessment of current UK National Health Service (NHS) benchmarking. It seeks to examine whether benchmarking is being used dynamically to disseminate best practice in healthcare, or whether it is primarily a government tool to enforce static competitive performance standards. Design/methodology/approach -Draws on recent literature and government pronouncements. It charts the development of the health care policy discourse that articulated a move from the internal market of the early 1990s to the metrics approach of New Labour. Findings -Benchmarking is one of the private sector-grown "managerialist" tools whose application and significance is rapidly increasing in the UK public sector. Despite its prevalence, the nature (competitive or comparative), the process (based on indicators or ideas) and the outcomes (standards or "best practice") of benchmarking in public services remain unclear. The findings reveal that benchmarking requirements, imposed by government policy, are articulated in terms of comparative ideas -benchmarking with the stated objective of "sharing best practice", but are operationalised and disseminated in the form of indicator league tables with standardised benchmarks for performance. Hence, there is an apparent "articulated policy -implemented practice gap". Concludes that, whilst benchmarking is a highly desirable policy instrument, its practical relevance to health care improvement is still in doubt. Originality/value -The findings are relevant to both NHS policy-makers and to NHS actors who must engage with the processes and outcomes of benchmarking practices.

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“…Recently, a considerable amount of literature has focussed on the subject of efficiency comparison among public health-care trusts (Ellwood, 1996;Dawson and Street, 2000;Dawson et al, 2001;Jones, 2002;Northcott and Llewellyn, 2002, 2003Llewellyn and Northcott, 2005;Barretta, 2005). A number of these studies (Ellwood, 1996;Jones, 2002;Llewellyn, 2002, 2003;Barretta, 2005) have underlined that:…”

Section: Bij 154mentioning

confidence: 99%

“…Recently, a considerable amount of literature has focussed on the subject of efficiency comparison among public health‐care trusts (Ellwood, 1996; Dawson and Street, 2000; Dawson et al , 2001; Jones, 2002; Northcott and Llewellyn, 2002, 2003, 2005; Llewellyn and Northcott, 2005; Barretta, 2005). A number of these studies (Ellwood, 1996; Jones, 2002; Northcott and Llewellyn, 2002, 2003; Barretta, 2005) have underlined that:the users of inter‐trust efficiency analyses believe that some factors (such as differences in cost‐allocation methods and the presence of external and internal special circumstances) have an impact on data variability and conceal “real (in)efficiency”;the presence of these “disturbing factors” is one of the prime contributors to unreliable data; andthe results obtained are only minimally used by trusts with the aim of benchmarking.Literature has presented a variety of strategies aimed at neutralising some of the “disturbance factors” that impede the focalisation on “real (in)efficiency” in inter‐trust efficiency comparisons, such as:defining and periodically updating a uniform costing system for all trusts (Ellwood, 1996; Jones, 2002; Northcott and Llewellyn, 2002, 2003);excluding any costs subjectively assigned to the cost object (so‐called indirect costs) from the analysis (Northcott and Llewellyn, 2003; Barretta, 2005); andcreating clusters of trusts (or their sub‐units) that present similar peculiarities with respect to their internal or external environments (Dawson et al , 2001; Northcott and Llewellyn, 2003; Barretta, 2005).…”

Section: Influences On Efficiency Performance Measurement and Reasons For Excluding Indirect Costs From Efficiency Benchmarkingmentioning

confidence: 99%

The exclusion of indirect costs from efficiency benchmarking

Barretta

2008

Benchmarking: An International Journal

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If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. AbstractPurpose -This study aims to evaluate the effects produced by a strategy aimed at neutralising one of the "disturbance factors" that may impede the focalisation on "real (in)efficiency" in relative efficiency assessments within the health-care sector: the exclusion of indirect costs from these comparative analyses. Design/methodology/approach -The empirical analysis is based on the statistical elaboration of data from a sample group of hospital sub-units within Italian health-care trusts. The analysis isolates the effect on efficiency indicator variability (dependent variable) of excluding indirect costs (independent variable). Findings -The analysis conducted has uncovered the likely manipulation of indirect costs to create the impression of having achieved approximately average levels of efficiency performance. The case analysed in this study shows how a defensive orientation in public organizations may arise even without the application of some form of compulsory benchmarking. Practical implications -The results observed highlight how the exclusion of indirect costspotentially allocated to attain cross-subsidization among cost objects -may help to uncover actual cases of (in)efficiency and thus aid in identifying "true" best practices. Originality/value -Literature has presented a variety of strategies aimed at neutralising some of the "disturbance factors" that impede the focalisation on "real (in)efficiency" in inter-trust efficiency comparisons. However, until now no studies have supplied evidence of the efficacy of the strategies in question in isolating "real (in)efficiency".

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Comparing NHS Hospital Unit Costs

Cited by 4 publications

References 3 publications

What Makes Organisations Measure? Hypotheses on the Causes and Conditions for Performance Measurement

What Makes Organisations Measure? Hypotheses on the Causes and Conditions for Performance Measurement

Benchmarking in UK health: a gap between policy and practice?

The exclusion of indirect costs from efficiency benchmarking

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Comparing NHS Hospital Unit Costs

Cited by 4 publications

References 3 publications

What Makes Organisations Measure? Hypotheses on the Causes and Conditions for Performance Measurement

What Makes Organisations Measure? Hypotheses on the Causes and Conditions for Performance Measurement

Benchmarking in UK health: a gap between policy and practice?

The exclusion of indirect costs from efficiency benchmarking

Contact Info

Product

Resources

About

What Makes Organisations Measure? Hypotheses on the Causes and Conditions for Performance Measurement

What Makes Organisations Measure? Hypotheses on the Causes and Conditions for Performance Measurement