In a recent study, “Building clinical engagement with costing,” CIMA’s Rebecca McCaffry has revealed a better way forward for both professions in addressing the ills of Britain’s National Health Service (NHS), which is facing its own financial ills amid pressure to improve financial performance without sacrificing patient outcomes.
Following reforms introduced in 2013, the NHS has faced dramatic changes, with an overall savings target of 20 billion British pounds (A$40 billion) over four years. Yet more than half its 40 foundation trusts were in deficit in the 2014 financial year, while concerns over patient care have grown following the “systemic failure” of the Mid-Staffordshire NHS Foundation Trust.
Accountants and doctors both agree on the need for improved engagement, with surveys showing that 96 percent of finance directors and 98 percent of senior clinicians consider “the provision of high quality, affordable services will only be achievable through strong clinical-financial engagement,” including such measures as greater use of patient-level costing data and clear incentives for quality and cost improvement.
Yet despite the development of patient-level information and costing systems (PLICS), research has revealed a clear disconnect between the roles of accountants and clinicians. This has occurred due to such factors as costing being “owned” by the finance function; the timing of the reporting cycle and a focus on budget control; and a “micro” focus that ignores the big picture.
According to the report, such barriers can be addressed by highlighting with business cases the clear and obvious benefit to clinicians of using costing information; leveraging clinical competitiveness through benchmarking; highlighting the role of information in service improvement; providing more information on department interdependencies; and supporting decisions with better costing information.
Building engagement
McCaffry urges both sides to improve engagement through a number of measures, improving ongoing clinical engagement and maximising available time for interactions, such as meeting clinicians in their surgical restrooms between operations.
Another recommendation is promoting “clinical champions” to overcome each function’s “highly codified tribal dialects.” One Trust addressed this by identifying clinicians as having “techie,” “forerunner” or “follower” personalities.
The author also urged relevant, accessible reporting, such as presenting system outputs in user-friendly formats. There also needs to be leadership from the top, with Board-level commitment to using costing information.
“Costing needs to become an enabling rather than a support function; whatever the perception of clinical and financial roles has been in the past, it is clear that both professions must work together to meet the challenge of delivering better-quality patient outcomes at a lower cost,” McCaffry concluded.
The study has obvious parallels to Australia, with Medicare facing rising cost challenges amid a greying society. By working together more closely, management accountants and clinicians can help ensure a tighter cost focus does not risk the ultimate goal of better public health.
