Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.668413
Title: Using information on variations to improve health system performance : from measurement to management
Author: Schang, Laura
ISNI:       0000 0004 5366 9736
Awarding Body: London School of Economics and Political Science (University of London)
Current Institution: London School of Economics and Political Science (University of London)
Date of Award: 2015
Availability of Full Text:
Access through EThOS:
Full text unavailable from EThOS. Please try the link below.
Access through Institution:
Abstract:
Although information on variations in healthcare utilisation is increasingly available, its constructive use to improve health systems is often hindered by the lack of a clear standard to evaluate what is “good“ and “poor“ performance. This thesis investigates how regulators and managers of the system might address this lack of a standard. The thesis distinguishes between the purpose (to manage ambiguity in the absence of a standard or to determine a meaningful standard) and the approach used to achieve either purpose (socio-political or technical-evidential). The resulting four types of strategies are examined by drawing on concepts and methods from public health and epidemiology, health economics, operations research and public administration and empirical evidence from England and Scotland. To manage ambiguity in the absence of a standard using a socio-political approach, the thesis finds that one must overcome a series of barriers including awareness, acceptance, perceived applicability and capacity of potential users. Clinical and managerial leadership appear to be enabling factors for the use of information on variations for strategic problem framing and stakeholder engagement. To manage ambiguity in the absence of a standard using a technical-evidential approach, the use of ranking intervals and dominance relations obtained from ratio-based efficiency analysis can help to avoid the forced assignment of a single, potentially controversial ranking to each organisation under scrutiny. To determine a standard using a technical-evidential approach, estimating capacity to benefit in populations provides a theoretically sound and feasible benchmark to assess the appropriateness of service utilisation against population needs. However, uncertainty about criteria of capacity to benefit and lack of epidemiological data remain practical challenges. To determine a standard using a socio-political approach, an experimentalist governance logic focused on learning and dialogue between central government and local organisations can complement a hierarchist logic focused on accountability when both the ideal ends and the means for attainment are ambiguous. As a whole, the thesis reinforces the insight that both improved technical tools and social and political processes are required to make information on variations useful to decision-makers.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.668413  DOI: Not available
Keywords: HD28 Management. Industrial Management
Share: