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Trusts with more managers perform better, study finds

Fri 14 Jul 2017

New academic research finds NHS trusts with a higher ratio of managers have better patient outcomes and are more efficient.

 NHS trusts with more managers – and better paid and more stable management teams – perform better than others, according to new research by academics due to be published next month.

Analysis of statistics from 150 acute trusts by researchers at Warwick, Bristol and Leeds found that trusts with a higher proportion of general managers did better on a range of measures including clinical outcomes, patient experience and efficiency. The study also revealed that higher levels of pay and stability for managers produced an even stronger positive impact on performance indicators. 

The researchers found that a 1% increase in the proportion of managers produced an average 3% improvement in efficiency and 2% improvement in patient experience scores – enough to lift most trusts into the top third of the performance rankings. Higher numbers of managers also led to a statistically significant improvement in infection rates, tests revealed.

Warwick Business School’s Ian Kirkpatrick, who worked on the research alongside Bristol University’s Gianluca Veronesi and Ali Altanlar of the University of Leeds, said the findings confounded claims by media commentators and policymakers that the NHS was over-managed, and showed that “managers, as a group, are making significant contributions to efficiency and improved patient care”.

He added: “The evidence shows, overall, the positive contributions of general managers appear to be greater than the costs and risks associated with ineffective management. This, we believe, is an important finding, and one which should not be ignored as the NHS gears up to deal with the very considerable funding and organisational challenges that lie ahead.” 

MiP chief executive Jon Restell said: “Research like this challenges the stereotype by showing why patient care directly benefits from properly rewarded managers in stable employment with the right skills and NHS values. Perhaps it’s time to think about ‘Safe Management Levels’ to back up ‘Safe Staffing Levels’. We treat managers and other support staff as second class employees at our patients’ peril.”

  • The study will published in full on 25 August. You can read more about the research in the Autumn issue of Healthcare Manager magazine.

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