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Management Reforms and performance in a London Teaching Hospital (pdf)
Tim Ensor, Anne Kilby, Jerrett Myers  & Roger Hay.

Exploratory research of inpatient services was undertaken in a large London Teaching Hospital to discover how and why working patterns had changed in response to reforms in the hospital and more widely across the NHS. A small, purposive sample of doctors (46) and nurses (48) drawn from all the major departments were questioned about their work patterns since 1980 and knowledge of reforms. Respondents also completed a psychometric enquiry. The results allowed proxies for
`intrinsic incentives’ to be compared with reported work patterns across the sample and over time.  Proxies for `extrinsic incentives’ (pay, employment regulation, management regime and team citizenship) were also assembled and compared with both clinical activity and productivity measures.

For doctors, the total number of hours as well as the number of hours worked in excess of contract has declined over time. Whilst doctors that favour association and are more altruistic and pleasure seeking are more likely to work unpaid hours than less `knightly’ types, the difference between the two groups appears to have declined over time suggesting that stronger management regimes may reduce some doctors’ motivation to ‘donate’ time but increase level of effort by others. For nurses the trends are less clear.

However, despite the overall reduction in the number of hours doctors worked, clinical activity and productivity, as reflected in finished consultant episodes per consultant, has increased in recent years. The paper concludes with a discussion of the possible components of a management regime that maximises the effort of `knights’ but mobilises the effort of `knaves.’ The conclusions are tentative but merit further work.

Further information is available at the research team’s Public Services Programme webpage as well as their site at the Oxford Policy Institute.