Current Events International Health Care Systems

Speed Surgery

Productivity.  More output with fewer inputs.  Increasing productivity is one of the few goals towards which all businesses strive. 

The Times of London reports (“Rankings to identify slow surgeons“) that the NHS will try to increase the productivity of surgeons in the UK. 

The system of “performance indicatorsâ€? will be announced this week by ministers, seeking to boost NHS productivity. A recent report from the King’s Fund, an independent advisory body, said patients had not benefited from a £340m salary increase for consultants.

NHS trust managers will be able to use the data — which will not be made public — to tell slow surgeons to copy the methods of faster colleagues.

Ministers point to the example of a specialist who more than doubled his output at a Norfolk hospital by using “production lineâ€? techniques learnt in France, which ensure he is never kept waiting for his next patient.

While increased productivity is a goal any economist would applaud, does this initiative really increase productivity?  In theory, the output good for any surgical procedure is improved health.  An increase in productivity would mean improving the average patient’s health using fewer inputs, such as a physician’s time.  The British initiative focuses only on the input side without taking to account how the change in the amount of time the physician spends on each surgery impacts the output (health).  Fewer inputs (physician time) likely means worse output (patient health).  The major problem of course is that measuring health outcomes is very difficult. 

Also, using a simple metrics to measure performance is often sub-optimal.  For instance, during my time working in finance for General Electric, I saw that individuals in the sales department would often slash their price at the end of a quarter in order to sell enough products to make their sales goals, despite the fact that this was not the most profitable way of conducting business.  Similarly, narrowing one’s focus to the time it takes to complete an operation will certainly increase the speed of the process but may not increase quality of care. 

In the U.S., fee-for-service doctors have an incentive to move faster, since the more patients they see, the more money they earn.  On the other hand, if a physician is known for doing shoddy surgical work, no patients will return to see them.  I do not know if physicians in the NHS have similar reputational issues to worry about; do British NHS patients get to choose their surgeon or are they assigned to one?

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