Transcript hmfried.com

McKinsey&Compa
ny
LSE
CENTRE for
ECONOMIC
PERFORMANCE
•Healthcare management practice findings
•Management
•really matters
Management practice is strongly related to:
Clinical outcomes
Patient satisfaction
Hospital financial performance
–
•–
•–
UK healthcare management practice: Good UK average
score Vs others Large intra-country variation creates a
real opportunity
•for improvement
–
•There is large
•variation
•Improvement
•is possible
–
5 factors are associated with better management practice:
Share of clinically trained managers
Degree of competition
Hospital size
Managerial autonomy
Hospital ownership
–
•–
•–
•–
•–
•9
•There is a strong relationship between management
•practice and health outcomes
•UK heart attack mortality rates
•10
5
•9
5
•9
5
•9
0
•3rd
•2nd
•Botto
•Top
m
•quartil
•quartil
•quartil
•quartil
e
e
•Management
practice
score e
e
•9
•Good management is correlated with better clinical and
•financial performance
•A one point increase in management practice is associated with
UK Hospitals
•▪6.5% reduction in risk adjusted 30 days AMI mortality rates
•▪33% increase in income per bed
•▪20% increase in the probability that the hospital is above average
•in terms of patients satisfaction
•
US Hospitals
•▪7% reduction in risk adjusted 30 days AMI mortality rates1
•▪14% increase in EBITDA per bed
•▪0.8 increase in the percentage of people that would recommend
•the hospital
•
•9
There is a wide variation in average hospital
management practice score by country
Average
Average with controls
•
•Management practice score –by country
US
•3.0
0
1.43
UK
•2.8
2
1.22
Sweden
1.24
0
Germany
France
.
9
9
•.6 2
4
•22.5
Canada
Italy
•2.6
8
1
.
0
6
2.48
0.86
2.40
0.75
•9
•The UK achieves high management practice scores relative
•to direct health expenditure
•Government health expenditure per capita, 2006
•$
•6,00
0
•U
S
•5,00
0
•4,00
0
•3,00
0
•2,00
0
•Franc
e
•Ital
y
•German
y
•Canad
a
•0.8 0.9 1.0 1.11.2
•Swede
n
•U
K
•1.3 1.4 1.5
•Management practice score
•9
•There is an even bigger variation of management practice
•scores within countries
•9
•Hospitals with more clinicians as managers have better
•management
•Management score relative to national mean
•0.9
7
•1.0
0
•1.0
1
•1.0
2
•3rd
•2nd
•Botto
•Top
m
•quartil
•quartil
•quartil
•quartil
e a clinicaledegree
•Proportion
ofemanagers with
e
•9
•Increases in clinically trained managers is correlated with
•improved management practices
•Change in management practice score1
•8.3
8
•9.3
5
•1.2
1
•0.3
1
•3rd
•2nd
•Botto
•Top
m
•quartil
•quartil
•quartil
•quartil
e
e
•Changeein the proportion
of managers
e •with a clinical degree1
•1 Percent
•9
•There is wide variation in the prevalence of clinically
•trained managers by country
•
•Percentage of managers with a clinical degree1
Sweden
93
US
74
Canada
74
Germany
71
France
64
UK
58
•1 Italy excluded as it is a legal requirement that all general managers have clinical degrees
•9
•Tougher competition appears to be good for management
•Management practice score
•2.5
9
•2.6
9
•2.8
2
•None 1 to 5 54 to 10
•Number of competitors1
•2.9
0
•More
•than
10
•1 As perceived by the manager.
•14
•There is a strong relationship between hospital size and
•management practice
•Management practice score
•2.4
4
•2.6
5
•2.7
1
•<100 100-499 500-1,499
•2.8
0
•>1,49
9
•Number of employees1
•1 Directly employed by the hospital
•14
•Managerial Autonomy is correlated with management
•practice
•Managerial Autonomy
•0.2
9
•0.1
4
•0.07
•0.31
•2nd
•3rd
•Botto
•Top
m
•quartil
•quartil
•quartil
•quartil
e
e
e
•Management
practice
score
e
•14
•Private hospitals tend to have higher management practice
•scores
•Management practice
•2.9
4
•2.6
0
•Private1Public
•Hospital ownership
•1 Private includes both for profit and not for profit organization
•14
•BREAKOUT: Applying the insights in your hospitals
•Horizon 2
•Horizon
3
•
•Horizon 1
•
•Increase share of
clinically trained
managers
• ▪ Create programmes
to give clinicians
hospital management
training (e.g., field and
forum)
• ▪ Develop explicit
succession criteria
and planning based
on both clinical and
managerial
•competencies
•Increase managerial
•autonomy
•▪ Strengthen service
•line management,
•especially talent and
performance
management
•
•
•
•
•
•
•
•
•
•
•
•
•
•Create internal proxies
for external factors
• ▪ Introduce a heightened
sense of performance
competition via
performance
transparency based on
relevant managerial
metrics and data
(Competition)
• ▪ Consider applying
elements of private
sector incentive
systems (e.g.,
differential
•compensation) (Private)
• ▪ Manage the reputation
and reality of being a
“centre of excellence”
(Size)
•14
•McKinsey’s OHI survey can help you set a baseline for
•Healthcare and Social
•Performance and Health across your
Assistance Sector
(n=6,946)
•0 25 50 75 100
hospital
•General Medical and
•Direction
•Alignment
Surgical Hospitals
(n=4,733)
•Leadership
•Envt &
Values
•Accountabilit
y
•Execution
•Coord &
Control
•Capabilitie
s
•Motivation
•Innovation
•Renewal
•External Orient
•Not Effective
•SOURCE: Imperial Healthcare Organizational Health Index Survey (n=256) 15
•Common
•Superior •Distinctive