We develop a new methodology for measuring management practices in hospitals, and use this in 182 interviews of physicians and managers in public and private hospitals (covering 61% of English acute trusts). We find our management measure is strongly correlated with hospital performance, both clinical outcomes like survival rates from heart attacks, and general operational and financial outcomes. Management in publicly owned hospitals (the National Health Service) compares poorly with management in manufacturing. These public hospitals also appear to have significantly worse management practices than private hospitals. Among publicly owned hospitals management scores are relatively higher for Foundation Trusts (hospitals with greater autonomy from the government), for larger hospitals and where managers have more clinical expertise. We also find some evidence that competition is associated with better hospital performance.
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