MANAGEMENT

Management Processes And Functions



Management processes and functions

1. Introduction

It is the intention of this paper to consider whether resource management (RM) as currently constituted in the National Health Service (NHS) is likely to fulfil its aim of efficiency. The paper draws attention to some of the limitations of economic theory as a tool to allow judgements to be made regarding the achievability of this aim. It then highlights those aspects of theory that might be useful in helping to develop RM in a way that will promote efficiency. Using these, the paper suggests why RM might not be successful, and thereafter outlines alternative actions that might promote efficiency better in the hospital sector.

The paper first outlines the aim of RM. The scene is then set by describing RM as a policy and as an actuality at hospital level. Having understood the fundamental aim implicit in the relevant NHS literature to be the promotion of efficient use of resources, the author asks whether, given the nature of RM, we can expect it to achieve this. It will be seen that there are two main features of RM: change in management structure, and the provision of information. The paper examines the change in management structure against the background of various economic theories of the hospital (especially the work of Harris) and assesses whether RM is likely to lead to the adoption of efficient medical practice. It also examines the evidence on whether information per se can help to promote hospital efficiency. It then draws on empirical evidence to identify other means of moving towards greater efficiency. Given these other means, the future form and role of RM are then discussed.

2. The aim of resource management

The stated aim of the Resource Management Initiative (RMI) is:

To enable the NHS to give a better service to its patients, by helping clinicians and other managers to make better informed judgements about how the resources they control can be used to the maximum effect.

This aim has been reiterated in several documents related to the implementation of the initiative. These documents claim that the initiative will result, for example, in 'better and more cost-effective care'. Packwood et al. identified four key elements of the DHSS statement:

a) improved quality of care as a result of the service providers . . having access to information about the effectiveness of different patterns of treatment and greater authority to determine the deployment of resources;

(b) involvement in management by the service providers [as] . . . these staff have a good idea of patient need [and] . . . are also in the best position to ensure resources are used to best effect;

(c) improved information to identify how resources are being used, with what effect and what are the alternatives;

(d) stronger control of resources that results from rational and responsible management and use of information, for resource allocation and determining service activities.

Of the four key elements of the 'aim' of resource management only the first (improved quality of care) is an end ...