RESOURCE MANAGEMENT IN HEALTHCARE

Posted: January 4th, 2023

RESOURCE MANAGEMENT IN HEALTHCARE

Name:

Course:

Professor’s Name:

University:

Date:

Resource Management in Healthcare

Healthcare systems around the world are under great pressure to offer high quality services amid resource constraints. The demand for high quality healthcare has not been matched with a commensurate increase in resource allocations from national budgets. In countries where universal healthcare service is entrenched, healthcare institutions are increasingly finding themselves running deficits as the cost of healthcare services they provide exceeds the budgetary allocations by governments (Watt, Charlesworth & Gershlick 2019. Consequently, while the governmental agencies in charge of healthcare demand that healthcare institutions utilise the scarce and diminishing resources prudently, healthcare institutions are faced with the dilemma of choosing between reducing access to certain healthcare services and curtailing some healthcare services, while efficiency enhancement present the least or no controversies. The choice between the two options is often controversial among the healthcare stakeholders, thus requiring the employment of advanced negotiation skills to convince the most critical stakeholders while pacifying the critics of either option (Department of Health 2013). This pits hospital boards of management against the public, healthcare practitioners, and politicians, who always argue against austerity programs and adjustments (Appleby & Harrison 2006). However, the boards of management can only persuade the stakeholders to accept one option over another when they confront them with well-argued facts, sound evidence, and logical or rational arguments for and against the preferred option.

Greenhart & District Hospitals NHS Trust have been running a £20 million recurring deficit against a £500 million turnover in revenues and is under pressure from the national health service (NHS) England to device a plan within six months, to eliminate the financial shortfall. While the Greenhart & District Hospitals board has already identified efficiency improvements can deliver £15 million in savings, the remaining £5 million is torn between two options, and the board is yet is yet to decide on the one on which it would base its deficit elimination plan. Specifically, the delivery of the outstanding £5million is challenged by the choice between closing a maternity centre or a paediatric centre. Both options would reduce access to maternal and paediatric services by transferring them to different hospitals under the trust board or directing referrals to healthcare centres outside the board’s jurisdiction.

The Greenhart & District Hospitals NHS Trust case forms the basis of the ensuing discussion on resource management in the healthcare sector. The discussion will summarise the lessons learned from similar decisions that have been made in other jurisdictions. This evidence will be used to describe the process for identifying the preferred option that would be chosen and the decision that would be presented to the board of management.    

Task 1: Summary of Lessons Learned

Many boards of management of healthcare institutions have encountered dilemmas similar to the one faced by the Greenhart & District Hospitals NHS Trust board and taken decisions on the fate of services offered in the hospitals and clinics under their jurisdiction. Overall, although health and social care in the United Kingdom has been availed free at the delivery points since 1948, the cost of social care in England has been shifted to the individual, incrementally over time, despite the healthcare workforce, health resources, and the country’s population having increased significantly in the same period (Watt, Charlesworth, & Gershlick 2019). In turn, the provision of healthcare services across healthcare organisations in the United Kingdom has been influenced by the need to balance quality, access and efficiency, growing demands amid changing demographics, and universal coverage. However, different countries employ different measures to identify the health services that deserved more resource allocation than did others. For instance, the United Kingdom’s healthcare system uses economic evaluation to determine the blend of healthcare services to fund. In this jurisdiction, the healthcare services that deserved funding are those that demonstrated a high or increasing quality-adjusted life year (QALY), which was used as the measure of the benefit accrued from health improvements (Morris, Devlin, & Parkin 2007). Other countries, like New Zealand, whose healthcare systems are publicly-funded and are based on the fixed budget system used similar criteria to make funding decisions at the national level. Contrastingly, France uses the cost-benefit criterion to make decisions about reimbursing medication providers, such as pharmaceuticals. In the same vein, different countries used economic evaluation to assess the variations in equity as a criterion for resource allocation. For instance, the United Kingdom uses regional variations in healthcare access, popularly known as “postcard prescribing” because it is based on residential location, to inform the availability of medical interventions and medications. For this reason, the healthcare system established the National Institute of Health and Clinical Excellence (NICE) to provide policy guidance on the cost-effectiveness and efficaciousness of novel healthcare technologies provided under the NHS, which is then used as a basis for resource allocation (Morris, Devlin, & Parkin 2007). However, while access inequity can lead to legal tussles in countries with fixed-budget healthcare systems, like those in France, Germany, and the United Kingdom, it is tolerable in other jurisdiction, such as the United States, where market forces are allowed to influence access to and cost of healthcare. In fact, in markets like the United States, profits drove healthcare quality and access because profitable hospitals attracted highly-skilled healthcare professionals, paid them higher salaries, and attracted more paying patients (Zurn et al. 2004). Therefore, private hospitals in urban settings delivered higher quality and more accessible healthcare compared to public ones in rural setting, further entrenching health outcome disparities in the country (Dong 2015).

Task 2: Process for Identifying Service Option

Identifying the healthcare service that would be closed or modified to enhance quality, accessibility, and cost-effectiveness concurrently, is a rigorous process that involves the application of best practices in decision-making. In the United Kingdom, the provision of universal healthcare is the overarching priority of the National Health Service (NHS) (Terwindt, Rajan, & Soucat 2016). This national vision of availing high quality, accessible and cost-effective healthcare service equitably to all in the United Kingdom should be reflected across all decision-making levels, from the national policy level to the institutional strategic and tactical level (Harradine, Prowle & Lowth 2011). The priority-setting process informs the choices made by the entire spectrum of healthcare sector stakeholders, including governments and healthcare organisations (Department of Health 2013). The choices that are prioritized by any organisation seeking to realise universal health coverage must reflect the vision and values of the society related thro the healthcare system they desire. However, considering that the resources allocated to health are finite, a comprehensive criteria that is inclusive of all stakeholders must be set at the onset, and the resultant choices must be informed by the evidence collected from a situation analysis (Terwindt, Rajan, & Soucat 2016). The outcome of the choices make are therefore, premised the most agreeable and rational option rather than the best alternative.

From this premise, the process that would be used to identify which service(s) should be closed commences with a situation analysis. In this case, the situation analysis will be used to gather evidence about the importance the two issues, namely, the maternity service and the paediatric service, that are causing the dilemma.  Other considerations in the situation analysis include the cost and efficaciousness of interventions used in the two issues, the acceptability of the options selected, and the fairness that the choice of one action or the other would deliver to the population served by the district general hospital and the community hospital under Greenhart & District Hospitals NHS Trust. The situation analysis will benefit from a SWOT analysis in which the strengths, weaknesses, opportunities and threats of the two healthcare organisations and their contribution to the health wellbeing of their target population will be deciphered (Terwindt, Rajan, & Soucat 2016). A critical activity in the situation analysis process is the involvement of all the significant stakeholders in a discussion that compares the benefits of the services delivered by the two healthcare institutions and the healthcare challenges that are yet to be resolved to yield the desired health outcomes. The stakeholder forum should be drawn from a wide base to include residents, healthcare professionals, policymakers, and patients from diverse cultural, socioeconomic, and political orientations. 

After the situation analysis, priority setting shall ensue and will be based on preset criteria that are informed by the vision and values of the community served by the district general hospital and the community hospital. The characteristics of this community will clarify their vision and values, which should be commensurate with the provision of the universal health ambitions of the NHS (Terwindt, Rajan, & Soucat 2016). The community in the town of Sleight has members experiencing poverty and are unemployed, and therefore likely to be disenfranchised because of their lack of finances to pay for health services. Therefore, cost-effectiveness is a critical criterion that will inform the priority-setting exercise. In the same vein, the lower cadre of the community members in this town are likely to value access to healthcare services. Moreover, the rural/urban setting of the areas served by the two hospitals influences the accessibility of health services, with the rural community being more disadvantaged compared to the urban one. Is this regard, the accessibility of healthcare services, which can be assessed by their proximity to the community will influence the priority setting outcomes significantly.

Once the criteria for priority setting has been formulation from the information the situation analysis, the successes and challenges of the maternity and paediatric services should be used to set the service priorities. Each service will be weighted according to the set criteria, which will help decide which service or services will be closed (Terwindt, Rajan, & Soucat 2016). If there is a clear difference between the priorities attached to the two services, the service that ranks higher will be selected to continue while the one that scores lowly will be recommended for closure. However, if the two services tie, both should be recommended closure.    

Task 3: Executive Summary of Decision for the Board

A decision to close specialist children’s orthopaedic surgery service at Greenhart Hospital shall be recommended to the Greenhart & District Hospitals NHS Trust board of management. This decision is arrived at following the rigorous process described in the previous section. Specifically, the situation analysis revealed that the community, particularly the patients, in the town of Sleight were more satisfied with the maternity service at the community hospital that championed by the midwives at the birth centre. However, the specialist children’s orthopaedic surgery service at Greenhart General Hospital seemed to please the board of management more than it delighted the community. The SWOT analysis revealed that the community hospital also deliver more social benefits by being the only employer in the town of Sleight and have generated new employment opportunities in the past 5 years, an achievement that the General Hospital has not realised. In this regard, the General hospital had delivered lesser health and social benefits compared to the community hospital, which the town’s community recognised.

After prioritising the two services based on the set criteria, the maternity service scored higher than the paediatric one. On the criterion of cost effectiveness, the community hospital’s maternity service was deliverable to the financially-disadvantaged residents of the smaller towns and villages surrounding the town of Sleight. In turn, the paediatric service would only transfer the surgery costs to the tertiary centre, thus not delivery any cost advantage. On the criterion of healthcare accessibility and equity, the community hospital service a more vulnerable population compared to the general hospital by service the smaller towns and villages surrounding the town of sleight.

Conclusion

The Greenhart & District Hospitals NHS Trust demonstrated the dilemmas healthcare systems experience when trying to balance health access, quality, and equity amid demands to cut down the cost of healthcare. This dilemma is more pronounced in healthcare systems that provide universal health coverage, such as the United Kingdom. The rigorous analysis of the case revealed that the board should plan to close the specialist children’s orthopaedic surgery service at Greenhart General Hospital because it delivered less cost-effectiveness, fairness, and access compared to the maternity service at the community hospital.

Reference List

Appleby, J & Harrison, A 2006, Spending on health care, How much is enough, King’s Fund.

Department of Health 2013, Effective clinical and financial engagement, A best practice guide for the NHS, National Health Service

Dong, GN 2015, ‘Performing well in financial management and quality of care. Evidence from: Hospital process measures for treatment of cardiovascular disease’, BMC Health Services Research, vol. 15, no.1, pp. 1-15.

Harradine, D, Prowle, M & Lowth, MG 2011, ‘A method for assessing the effectiveness of NHS budgeting and its application to a NHS Foundation Trust. CIMA Research Executive Summary Series, vol. 17, no.10, pp.1-9.

Morris, S, Devlin, N & Parkin, D 2007. Economic analysis in health care. John Wiley & Sons.

Terwindt, F, Rajan, D & Soucat, A 2016, Priority-setting for national health policies, strategies and plan. In Strategizing national health in the 21st century: A handbook, World Health Organization.

Watt, T, Charlesworth, A & Gershlick, B 2019, ‘Health and care spending and its value, past, present and future’, Future Healthcare Journal, vol. 6, no. 2, pp. 99-105.

Watt, T, Charlesworth, A & Gershlick, B 2019, ‘Health and care spending and its value, past, present and future’, Future Healthcare Journal, vol. 6, no. 2, pp. 99-105.

Zurn, P, Dal Poz, MR, Stilwell, B & Adams, O 2004, ‘Imbalance in the health workforce’, Human Resources for Health, vol. 2, no. 1, pp.1-12.