It will be all over by the time you read this piece. Deadlines mean that the outcome of the General Election will elude me. But, you may well ask: ‘Will the result actually make any difference to dentistry?’
The question I’ve been asked most over the past weeks has been: ‘Which Party do you think will be the best for dentistry?’ The best answer I can come up with is that the same song is being sung, in different keys, by each of the three main contenders. All have assured us that “front line health services” will not be cut, but that “efficiency measures” – mostly unspecified in any detail – will be applied across the public sector.
The populist view is that “management” is to blame for the ills of the NHS. Many statistics have been produced typically to show that managers have increased by a zillion per cent, but hard pressed and competent clinical staff are in short supply.
One problem with this view is that many “managers” in the NHS are also clinically qualified (40% was an estimate I was given by a reliable external source). So the lines are perpetually blurred and many role-specifications cross the boundary between clinical and management functions.
“Better management” is something that everyone would like to see, but the concept is usually poorly defined – what is better management – and does it actually make any difference to clinical outcomes and effectiveness?
Now those are interesting questions and could legitimately be applied to dentistry, whether we are talking about local management through a PCT or Health Board, or practice management in any dental enterprise, corporate, individual, NHS, mixed or private.
The bad news is that there is very little good evidence on the effectiveness of management in primary care dentistry. A literature search reveals a paucity of good studies which link good clinical outcomes to quality management, and yet these are both topics which feature greatly in our current thinking.
So I was particularly interested in a summary report* of a large-scale study in general healthcare which could certainly do with some follow-up in the dental domain. A team of researchers first defined what “good management practice” meant and set about comparing large (non-healthcare) companies, smaller companies, NHS Trusts and private hospitals.
In each case the organisation was graded high, medium or low on these objective criteria. A set of outcome measures was similarly defined and measured: patient safety, clinical results, patient experience, productivity and financial aspects were all included.
Finally, the management and clinical staff in the hospitals were interviewed on a double-blind basis – neither the interviewers nor the interviewees were aware of the scores their establishment had attained.
The results were fascinating. Firstly, it was established that good clinical outcomes were directly related to high management standards (and for that you need good managers as well as good clinicians). Secondly, and tellingly to me, management views of ‘How good is the management here?’ bore little relation to actual outcomes, but clinicians’ opinions of the quality of management were most certainly and positively correlated. So if you want to know how well a hospital, clinic or trust is managed, ask the clinicians, is the short answer.
Now I’m reporting an external study, so don’t shoot the messenger here, but on average, NHS hospitals underperformed large UK manufacturers by 14% on efficiency, 21% on performance management and 30% on talent management. Private hospitals did significantly better on overall management scores than NHS hospitals, and most importantly in the talent management stakes.
My perception is that the engagement and retention of excellence in both clinical and management staff is the key to successful outcomes, both clinical and financial. Obvious you may say, but nice all the same to have it confirmed. It would be fascinating to apply the same methodology to dental practices – and also fascinating to see whether the “sea change” we are promised with a new Government, of whatever colour, will take the opportunity presented this month to act on research such as this before wielding the axe.