Management of the NHS

Even more people than normal are commenting on this subject in the wake of the publication of the Francis Report into the problems at Mid Staffordshire Hospital. Articles are written, blogs are promulgated, and animated discussions take place at dinner parties. I have been struck in all this material by the confidence with which the various commentators stake out their position. It seems that everybody has a remedy; they all know what to do. Many of the solutions are extraordinarily anodyne and of the ‘we need to change the culture’ type. Many others invoke more specific remedies which always make great sense to the commentator but for which empirical evidence is in very short supply.

It seems to me that we are massively ignorant about how to improve the health service. Much management research is of very little help, since it is not designed in a way that can reliably lead to cause and effect inferences.1 It seems to me that much more rigorous quantitative research is required and I would refer readers to a paper that will be coming out in Annals of Internal Medicine in the first week of March2 which points the way to overviews of quantitative evidence on service improvement with particular reference to patient safety.

1. Lilford RJ, Dobbie F, Warren R, Braunholtz D, Boaden R. Top-rated British business research: Has the emperor got any clothes? Health Serv Manage Res. 2003;16(3):147-154.

2. Shekelle et al. The Top Patient Safety Strategies That Can be Encouraged for Adoption Now. Annals of Internal Medicine – imminent.


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