Gianluca Veronesi

Clinicians on the board: what difference does it make?

Around the world clinical professionals have increased their involvement in the management of health services. However the evidence to suggest that these changes will lead to improved performance remains fragmented. In this paper we address this matter focussing on the impact of clinicians appointed to the boards of directors of English NHS hospital trusts. Although the number of clinicians involved in the strategic governance of hospital trusts is relatively low by international standards, they do appear to have an impact on overall performance. Drawing on published information from hospital trust annual reports, publicly available performance measures from the Healthcare Commission and data gathered by Dr Foster over a three year period (2006-9), the paper reports two main findings. First, the analysis reveals a significant and positive association between a higher percentage of clinicians on boards and the quality ratings of service providers, especially where doctors are concerned. This positive influence is also confirmed in relation to lower morbidity rates and tests to exclude the possibility of reverse causality (doctors joining boards of already successful organisations). Second, we do not find the same level of support for clinical professions such as nurses and other allied health professions turned directors.

Lessons from the Northern Rock affair

Purpose - This paper seeks to analyse reasons behind the difficulties faced by Northern Rock (NR) and the UK financial system and proposes a return to a more traditional/prudent banking business model, based on a sound balance between sources and uses of funds. Design/methodology/approach - The paper outlines the background to the credit crunch and presents a simple model of a bank and NRs business model. Conclusions and implications are drawn. Findings - It is suggested that credit rating agencies should provide a better assessment of the risks involved in securitised instruments by focusing on clarity and transparency and hence allowing liquidity risk of loan originators to be comprehensively understood. Moreover, the efficacy of the existing regulatory framework requires the tripartite system of supervision (Treasury, Bank of England, and FSA) to assume a more alert role in order to avoid asset bubbles in the first place rather than intervening Originality/value - The paper will give rise to a series of new research streams – all of which are much needed, given the fragile state of the financial systems.

National Health Service Boards of Directors and Governance Models

Abstract This article reports the findings of a year-long research project focused on the activity of boards of directors of twenty-two trusts from the British National Health Service (NHS). The evidence gathered through the use of semi-structured interviews, focus groups, workshops, feedback questionnaires and document analysis indicates that the behavioural dynamics of boards, affected by the dominance of the expert model, act as antecedents of their statutory functions and the implementation of different governance models. Only a portion of the boards involved has effectively incorporated in its modus operandi post-New Public Management (post-NPM) principles of governance.

Does clinical management improve efficiency? Evidence from the English National Health Service

The paper investigates the presence and impact of clinicians on the boards of National Health Service (NHS) acute care trusts on efficiency over a three-year period (2006–2009). The analysis shows an increase, albeit marginal, in the number of clinically qualified directors in the period under investigation. Furthermore, it reveals that the percentage of clinicians—and, more specifically, doctors—at the board level is positively associated to the rating achieved for the financial management of resources. Although the results need to be treated cautiously, they do lend support to the argument that increased clinical involvement in management decision-making will have benefits for the performance of hospital services.

Patient and Public Participation in the English NHS: An assessment of experimental implementation processes

This article analyses the impact of the implementation of a set of policies introduced after 1997 in the English National Health Service aimed at increasing patient and public involvement in organizational decision-making processes. Adopting the ambiguity/conflict policy implementation model and based on a year-long research project, it shows that patient and public engagement can be more effectively achieved when there is room for interpretation and discretion in selecting the means for involvement. Local initiatives, based on effective leadership governance mechanisms and organizational learning processes, are more likely to generate inclusiveness, shared ownership, and user-centredness than a top-down framework for involvement.

NHS boards: knowing the ‘what’ but not the ‘how’

Boards of directors play an increasingly fundamental role in British NHS trusts as well as other parts of the public sector. This study shows that their effectiveness is compromised by issues related to internal dynamics, processes, responsibility, overall functions and performance. The focus of governance, therefore, needs to shift from structural concerns to the multiple collective aspects of a boards behaviour.

A (new) model of board of directors: evidence from the National Health Service

Purpose – The paper aims to investigate the collective behaviour of boards of directors in 22 English National Health Service trusts and how this impacts on the exercise of their role and functions. Furthermore, it aims to shed light on the governance model characterising boards of health sector organisations.Design/methodology/approach – The data were gathered using a range of qualitative techniques (96 semi‐structured interviews, focus groups, workshops and document analysis) with a multiple case study approach.Findings – Owing to the existence of overlapping governance ideologies, health care boards are characterised by different internal dynamics, processes and levels of engagement in the exercise of their tasks. Post‐new public managment driven boards emphasise a pronounced collective approach in their internal proceedings, a wider perspective in strategising and a greater stakeholder involvement in decision‐making processes. These characteristics are particularly evident in boards of foundation trus...

Governance, transparency and alignment in the Council of Australian Governments (COAG) 2011 National Health Reform Agreement

OBJECTIVE This article provides a policy analysis of the Australian governments National Health Reform Agreement (NHRA) by bringing to the foreground the governance arrangements underpinning the two arms of the national reforms, to primary health care and hospital services. METHODS The article analyses the NHRA document and mandate, and contextualises the changes introduced vis-à-vis the complex characteristics of the Australian health care system. Specifically, it discusses the coherence of the agreement and its underlying objectives, and the consistency and logic of the governance arrangements introduced. RESULTS The policy analysis highlights the rationalisation of the responsibilities between the Commonwealth and states and territories, the commitment towards a funding arrangement based on uniform measures of performance and the troubled emergence of a more decentralised nation-wide homogenisation of governance arrangements, plus efforts to improve transparency, accountability and statutory support to increase the standards of quality of care and safety. CONCLUSIONS It is suggested that the NHRA falls short of adequately supporting integration between primary, secondary and tertiary health care provision and facilitating greater integration in chronic disease management in primary care. Successfully addressing this will unlock further value from the reforms.

The Significance and Implications of Being a Subprime Homeowner in the UK

The purpose of this paper is to provide a deeper understanding of the significance and implications of being a subprime homeowner in the UK. The results indicate that subprime individuals represent a mixture of socioeconomic groups, predominantly included in the light adverse and near prime categories of subprime lending, for whom credit adversity is generally a temporary phenomenon, which is likely to represent a transitory event in their lives. These borrowers have been at the heart of the UK subprime mortgage market, actively targeted not only by specialist lenders but also, more crucially, by mainstream players. Whereas for some individuals this market has provided an opportunity to experience the emotional and financial aspects of homeownership positively; for others becoming a subprime mortgage holder has increased the difficulties in their lives, affected their financial capability, and worsened their standards of living. Thus, the impact of the risk—reward mechanisms of subprime products has proved to be a difficult reality for certain socioeconomic groups. Furthermore, given the progressive deterioration in the transparency of the financial services industry, a significant proportion of subprime individuals has, unsurprisingly, struggled to appreciate the reasons why they faced problems in obtaining credit or a mortgage.

Exploring regionalism in public management reforms: the case of the Italian hospital sector

Although comparative research on new public management reforms has identified variable pathways of change between countries, less is known about variations within countries where there has been significant political and administrative decentralisation to regional tiers of government. In this paper we address this concern, focusing on public hospital management reforms in the Italian Servizio Sanitario Nazionale (SSN) as an illustrative case. Drawing on a range of publicly available administrative data sources we find that there is a significant regional dimension, with more autonomous regional governments with centre-right political majorities being more likely to adopt corporate-style management practices at hospital level.