English hospitals can improve their performance

NHS hospitals have substantial scope to improve their efficiency by adopting best practice, according to research published today by Professor Andrew Street and colleagues at the Centre for Health Economics (CHE) at the University of York.

With the NHS facing severe funding constraints, it has been suggested that the greatest potential savings may come from increasing efficiencies and by reducing variations in clinical practices. When comparing hospitals, variations in practice of any form are often cited as evidence of inefficiency or poor performance and that the overall efficiency of the health system would improve if all hospitals were able to meet the standards of the best.

The CHE researchers assessed whether or not the higher cost or length of stay is due to the type of patients that hospitals treat.

For ten conditions, the researchers examined the cost and length of stay for every patient admitted to English hospitals during 2007/8. They looked at three medical conditions (acute myocardial infarction; childbirth; stroke) and seven surgical treatments (appendectomy; breast cancer (mastectomy); coronary artery bypass graft; cholecystectomy; inguinal hernia repair; hip replacement; and knee replacement).

Even after taking account of age, disease severity and other characteristics, patients in some hospitals still had substantially higher costs or longer length of stay than others. This pattern was evident in all ten clinical areas. Furthermore, these variations could not be explained by hospital characteristics such as size, teaching status, and how specialised the hospital was.

Andrew Street commented: “Our findings demonstrate that most hospitals have scope to make efficiency savings in at least one of the clinical areas considered by this study. Inexplicable higher costs or lengths of stay suggest room for improvement. Unless hospitals improve their use of resources, they could struggle financially.”