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Article
Publication date: 1 April 1993

Penelope M. Mullen

Waiting lists have been a cause of concern since the inception ofthe NHS. Many theories have been put forward to explain their existenceand there have been many proposals…

Abstract

Waiting lists have been a cause of concern since the inception of the NHS. Many theories have been put forward to explain their existence and there have been many proposals to reduce their length. With the current changes in the NHS and the introduction of the Patient′s Charter has come a renewed emphasis on reducing waiting lists and waiting times. However, analysis of incentives within the new system suggests that waiting lists may be reduced by limiting access rather than by increasing treatment rate. Further, not only GP Fundholding, but also the contractual relationships between District Health Authorities and hospitals may lead to two‐tier systems, with admission priorities based on source of funding rather than clinical urgency. Overall, it is concluded that the NHS Review may result in fewer people obtaining treatment, but with shorter waits for those who do receive treatment.

Details

Journal of Management in Medicine, vol. 7 no. 4
Type: Research Article
ISSN: 0268-9235

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Article
Publication date: 1 June 2004

J.L. Foote, N.H. North and D.J. Houston

Hospital waiting lists are a feature of publicly funded health services that result when demand appears to exceed supply. While much has been written about surgical waiting

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Abstract

Hospital waiting lists are a feature of publicly funded health services that result when demand appears to exceed supply. While much has been written about surgical waiting lists, little is known about the dynamics of radiology waiting lists, which is surprising given that rational treatment, and indeed the medical profession's claim to expertise, rests on establishing a diagnosis. This paper reports the findings of a case study of a problematic ultrasound waiting list. In particular, this paper highlights how the management of the ultrasound waiting list served to subordinate the needs of waiting patients and their general practitioners to the interests and values of radiologists. Radiologist concern to protect specialist expertise from encroachment by outpatient clinicians and sonographers is implicated in the growth of the ultrasound waiting list. It is argued that an adequate understanding of ultrasound waiting lists depends on grasping how radiologists are successful in structuring problems of access in ways that enhance radiologist control over ultrasound imaging. The case study reported helps to shed light on why increasing funding to clear waiting lists proves ineffective.

Details

Journal of Health Organization and Management, vol. 18 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 July 2006

Patrick Kenis

To develop propositions on why public policies towards decreasing waiting list in health care can be expected to be unsuccessful.

Abstract

Purpose

To develop propositions on why public policies towards decreasing waiting list in health care can be expected to be unsuccessful.

Design/methodology/approach

On the basis of a case study of public policies directed towards the reduction of the waiting lists in health care a number of propositions are formulated explaining why this policy has turned out to be ineffective. The propositions are based on theoretical insights form the field of organizations studies about the behavior of organizations and professionals.

Findings

It is demonstrated that public policies on reducing waiting lists in the Dutch health care system are likely to be ineffective because the policy‐making strategies used are based on unrealistic assumptions about the behavior of organizations and professionals who are expected to reduce the waiting lists.

Research limitations/implications

Although the propositions are based on established organization literature, empirically they are only based on one case study.

Practical implications

In order to develop effective policy interventions it is important to be realistic about the behavior and strategies of the actors towards which the policy is directed. Moreover, rather than directing exclusive attention to those waiting, it is important for policy makers to address the interdependencies of the organizational field in which waiting lists occur.

Originality/value

This paper gives directions to policy makers who need to deal with complex and interdependent problems.

Details

Journal of Health Organization and Management, vol. 20 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 10 August 2010

David A. Buchanan and John Storey

This paper aims to explore the theoretical and practical management implications of a case involving the falsification of hospital patient waiting lists for elective…

Abstract

Purpose

This paper aims to explore the theoretical and practical management implications of a case involving the falsification of hospital patient waiting lists for elective orthopaedic surgery.

Design/methodology/approach

This case study is based on qualitative schedule‐structured interviews with 20 senior hospital staff (managerial and clinical), including the head of the investigation team, downloads from the hospital website, and internal hospital documentation. Those data were used to construct an event narrative exploring the underlying causes and implications of the incident.

Findings

The blame for misconduct pointed at three surgeons, a senior manager, a general manager, an assistant general manager, one administrative staff member, and several organizational factors. In addition to censuring some of those involved, an investigation recommended changes to training and working practices, policies and procedures, governance arrangements, and organization culture, and led to an external evaluation of the hospital board. However, one year later, another similar incident occurred.

Research limitations/implications

This is a single case, and events are viewed through a management lens, the individuals concerned being protected by research ethics considerations.

Practical implications

By detailing the sequence of events, surrounding conditions, and the reactions of multiple players, this analysis reveals typified responses to incidents of this kind, and the limitations inherent in post‐event investigations. If the benefits derived from national targets are to be realized in a manner which commands support from staff at all levels, then greater attention should be paid by managers and regulators to issues of transparency, responsiveness, and honesty. As core dimensions of good governance, managers must be accountable for helping to meet targets, and also for tracking how targets are met, ensuring that resources are made available, and that problematic issues raised are promptly and effectively addressed.

Originality/value

Studies of organizational misbehaviour are rare in healthcare where the focus often lies with patient deaths and injuries arising from system failures and gross individual misconduct. The analysis in this case explores the organizational conditions that contribute to such incidents.

Details

Journal of Health Organization and Management, vol. 24 no. 4
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 17 July 2009

Ulla Isosaari, Seija Ollila and Pirkko Vartiainen

The allocation of resources is a complex problem in health care. In Finland there has been an effort to solve the problems with a program called “Securing the Future of…

Abstract

Purpose

The allocation of resources is a complex problem in health care. In Finland there has been an effort to solve the problems with a program called “Securing the Future of Health Care”. The main focus of this research is on assessing how managers view the health care policy called guarantee of care from an ethical perspective.

Design/methodology/approach

The theoretical basis of the research covers theories regarding rationing, prioritization, as well as the ethics of health care. The empirical data were gathered through an internet questionnaire. The questionnaires were sent to the top managers in all Finnish health care districts (20 in all). The data were analyzed qualitatively.

Findings

According to respondents, ensuring access to treatment partially fulfilled the ethical principles of the right to good care, respect for human dignity, fairness, and co‐operation and mutual respect quite well. On the other hand, trust, impressiveness, non‐partiality in decision making and the right of self‐determination were not as well realized. The shortening of waiting lists had caused exhaustion and motivation problems among personnel and in addition, staff shortages were being experienced.

Originality/value

The administrators of the hospital districts agreed that centralizing resources as a reconstructive action is ethically wrong for the whole health care system. There is a great need for an ethical discussion concerning the choices made in health care policy. Long‐term results need sustainable solutions.

Details

Leadership in Health Services, vol. 22 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 1 April 1990

Sue Sullivan and Mike Ponton

National Health Service (NHS) waiting list problems have many complex causes. The results of research conducted to understand the complexities of patient need and demand…

Abstract

National Health Service (NHS) waiting list problems have many complex causes. The results of research conducted to understand the complexities of patient need and demand, factors influencing general practitioner referral decisions, factors determining the numbers of patients seen by consultants, and the criteria used for selecting patients from the waiting lists are described.

Details

International Journal of Health Care Quality Assurance, vol. 3 no. 4
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 1 March 1991

R.R. West, S.J. Frankel and R.E. Roberts

A study comprising both questionnaire and interview of patientswaiting for general surgery revealed that the majority of patientssuffer from relatively few clinical…

Abstract

A study comprising both questionnaire and interview of patients waiting for general surgery revealed that the majority of patients suffer from relatively few clinical conditions, that more than three‐quarters had been on the in‐patient list for over a year and that they suffered significant pain while waiting. Patients added to long lists with initially non‐serious (non‐life‐threatening) conditions may be overlooked, yet their clinical and associated social conditions may deteriorate. Since treatment for these conditions is generally effective, many patients would benefit from more organised queue management and earlier surgery.

Details

Journal of Management in Medicine, vol. 5 no. 3
Type: Research Article
ISSN: 0268-9235

Keywords

Article
Publication date: 4 October 2011

Henrik Eriksson, Ing‐Marie Bergbrant, Ingela Berrum and Boel Mörck

The aim of this paper is to investigate how waiting lists or queues could be reduced without adding more resources; and to describe what factors sustain reduced waiting‐times.

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Abstract

Purpose

The aim of this paper is to investigate how waiting lists or queues could be reduced without adding more resources; and to describe what factors sustain reduced waiting‐times.

Design/methodology/approach

Cases were selected according to successful and sustained queue reduction. The approach in this study is action research.

Findings

Accessibility improved as out‐patient waiting lists for two clinics were reduced. The main success was working towards matching demand and capacity. It has been possible to sustain the improvements.

Research limitations/implications

Results should be viewed cautiously. Transferring and generalizing outcomes from this study is for readers to consider. However, accessible healthcare may be possible by paying more attention to existing solutions.

Practical implications

The study indicates that queue reduction activities should include acquiring knowledge about theories and methods to improve accessibility, finding ways to monitor varying demand and capacity, and to improve patient processing by reducing variations.

Originality/value

Accessibility is considered an important dimension when measuring service quality. However, there are few articles on how clinic staff sustain reduces waiting lists. This paper contributes accessible knowledge to the field.

Details

International Journal of Health Care Quality Assurance, vol. 24 no. 8
Type: Research Article
ISSN: 0952-6862

Keywords

Content available
Article
Publication date: 1 April 2002

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Abstract

Details

International Journal of Health Care Quality Assurance, vol. 15 no. 2
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 24 February 2022

Gillian Vesty, Olga Kokshagina, Miia Jansson, France Cheong and Kerryn Butler-Henderson

Despite major progress made in improving the health and well-being of millions of people, more efforts are needed for investment in 21st century health care. However…

Abstract

Purpose

Despite major progress made in improving the health and well-being of millions of people, more efforts are needed for investment in 21st century health care. However, public hospital waiting lists continue to grow. At the same time, there has been increased investment in e-health and digital interventions to enhance population health and reduce hospital admissions. The purpose of this study is to highlight the accounting challenges associated with measuring, investing and accounting for value in this setting. The authors argue that this requires more nuanced performance metrics that effect a shift from a technical practice to one that embraces social and moral values.

Design/methodology/approach

This research is based on field interviews held with clinicians, accountants and administrators in public hospitals throughout Australia and Europe. The field research and multidisciplinary narratives offer insights and issues relating to value and valuing and managing digital health investment decisions for the post-COVID-19 “value-based health-care” future of accounting in the hospital setting.

Findings

The authors find that the complex activity-based hospital funding models operate as a black box, with limited clinician understanding and hybridised accounting expertise for informed social, moral and ethical decision-making. While there is malleability of the health economics-derived activity-based hospital funding models, value contestation and conflict are evident in the operationalisation of these models in practice. Activity-based funding (ABF) mechanisms reward patient throughput volumes in hospitals but at the same time stymie investment in digital health. Although classified as strategic investments, there is a limit to strategic planning.

Research limitations/implications

Accounting in public hospitals has become increasingly visible and contested during the pandemic-driven health-care crisis. Further research is required to examine the hybridising accounting expertise as it is increasingly implicated in the incremental changes to ABF in the emergence of value-based health care and associated digital health investment strategies. Despite operationalising these health economic models in practice, accountants are currently being blamed for dysfunctional health-care decisions. Further education for practicing accountants is required to effect operational change. This includes education on the significant moral and ethical dilemmas that result from accounting for patient mix choices in public hospital service provision.

Originality/value

This research involved a multidisciplinary team from accounting, digital health, information systems, value-based health care and clinical expertise. Unique insights on the move to digital health care are provided. This study contributes to policy development and the limited value-based health-care literature in accounting.

Details

Meditari Accountancy Research, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2049-372X

Keywords

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