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Session: Health System Performance
Room: Ball Room
Time: Sat 08:30-09:45

Presenter: Jon Sussex (Office of Health Economics. )

Abstract

Aims and background

Poorly managed performance problems with individual clinicians impose costs and damage to health services, patients and staff. The National Clinical Assessment Service (NCAS) in the UK National Health Service (NHS) provides publicly funded health services across the UK with advice, support, assessment and education services to improve the management of problem doctors, dentists and pharmacists. Around 800 cases are referred to NCAS, annually.

Our research investigates the value of NCAS services to referrers in the NHS, i.e. the people who use NCAS services. This is not straightforward because NCAS is funded at the national level and thus senior managers, who refer cases to NCAS, do not pay for its services. NCAS appears to be a unique organisation: internationally, no other health care system has a single agency responsible for these tasks. But clinical performance concerns arise everywhere. Hence the value of services to help manage clinical performance concerns is of international relevance.

Method

We use a ‘mixed methods’ approach, combining both qualitative and quantitative research methods in three stages. First, interviews with performance concern experts and a review of literature determined the potential benefits of a service to manage clinical performance concerns. Second, based on the first stage’s findings, we held discussion groups with referrers from across the NHS. Third, we use a discrete choice experiment (DCE) to elicit the values that senior managers, across all 600 UK NHS organisations, attach to services that might help them to manage clinical performance concerns. The results of the discussion groups were used to identify the most important aspects of a service to manage clinical performance and these were included as attributes and levels in the DCE. The DCE questionnaires are being distributed early in 2010.

Results and conclusions

The potential benefits of NCAS services identified from the literature are: saving costs of locum cover, management time, and legal advice; improved staff morale and productivity; an effect on the welfare of the clinician concerned; improved public confidence in NHS services and better patient outcomes.

Discussion group participants valued the expertise of an external group with cumulative national experience. Intuitively, the seriousness of the performance concern determines whether participants seek external help. In particular, participants worried about escalating a less serious problem, and committing to a burdensome process.

The DCE attributes identified from the discussion groups were: type of advice, facilitation of meetings, type of assessment(s) (performance, health, behavioural, workplace) and service cost. The DCE presented methodological challenges because of the unusual nature of the services being valued, which are akin to packages of highly specialised insurance.

The results of the DCE are expected by the end of May 2010 and will be presented. From the results of the DCE we will identify: the relative importance of each attribute and the value of the service and services attributes. We will also investigate how preferences differ across the sample.

Key Terms

Clinical performance, clinical assessment, service evaluation, discrete choice experiment

Authors:

Jon Sussex (Office of Health Economics) , Verity Watson (University of Aberdeen. Health Economics Research Unit) , Ebenezer Tetteh (Office of Health Economics) and Mandy Ryan (University of Aberdeen. Health Economics Research Unit)

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