The information revolution, health reform and doctor-manager relations
| Published date | 01 January 1999 |
| Author | Bruce Wood |
| DOI | 10.1177/095207679901400101 |
| Date | 01 January 1999 |
| Subject Matter | Articles |
The
information
revolution,
health
reform
and
doctor-manager
relations
Bruce
Wood
University
of
Manchester
Abstract
In
the
1980s
and
1990s
in
both
Britain
and
America
computerisation
of
patient
data
led
to
a
raft
of
comparative
performance
indicators.
The
'information
revolution'
began
with
measures
of
efficiency
(or
outputs,
such
as
bed
usage
and
length
of
hospital
stay);
more
recently
attention
has
begun
to
focus
on
effectiveness
(or
clinical
outcomes,
as
in
the
case
of
evidence-based
medicine).
Simultaneously
health
reforms
centred,
in
Britain,
on
improved
management
systems
and
the
introduction
of
a
quasi-market,
and,
in
the
United
States,
on
managed
care,
cost
controls
and
hospital
mergers.
This
case-study
of
an
American
general
hospital
uses
the
classic
Alford
framework
of
three
groups
of
structural
interests
(doctors,
managers
and
patients)
to
assess
the
impact
of
these
informational
and
organisational
developments
on
doctor-manager
relations
in
Britain
and
America.
Cross-cutting
local
alliances
based
on
common
interests
indicate
that
Alford's
groups
of
structural
interests
should
not
be
perceived
as
monolithic.
Introduction
Twenty
years
ago
the
British
data
on
NHS
hospitals'
workloads
included
the
numbers
of
patients
leaving
their
care
under
just
one
undifferentiated
heading:
'Deaths
and
Discharges'.
So
basic
and
unsophisticated
was
the
quality
of
that
data
that
it
did
not
reveal
how
many
left
hospital
in
good
health,
still
ill,
or
in
a
coffin!
The
information
revolution
of
the
1980s
saw
the
first
production
of
perfor-
mance
indicators
based
on
inter-hospital
comparisons
(see
Harrison
&
Pollitt,
1994,
pp.54-6
for
the
history).
The
initial
data,
for
1981,
was
both
unusable
as
management
information
(because
about
7,000
indicators
were
used
-
the
'regional
summary'
for
the
north-west
alone
ran
to
188
pages,
weighed
over
l1b,
and
yet
was
officially
described
by
the
Department
of
Health
&
Social
Security
Public
Policy
and
Administration
Volume
14
No.
I
Spring
1999
I
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