In a previous post I
showed that most high mortality trusts did not pay bank holiday extra
rates/wages to staff for the Queen’s diamond jubilee bank holiday,
while most low mortality trusts paid higher wages.
A friend of mine who
is an academic wrote back to me and said he could not resist doing a chi square on the
numbers and found the p=0.01. I am no don to argue or explain stats but
irrespective of statistical significance it is important to probe if
there might be a deeper meaning or relevance.
It is important to
understand why the high mortality trusts did not pay higher holiday
rates. Are they ‘mean spirited’ as the Unite Union portrayed
them?
In my mind the
underlying reasons are very simple and here it is:
QUALITY IS INVERSELY
PROPORTIONAL TO COST
And a high HSMR is
broadly speaking poor quality care.
Financial reasons?
It might be something as simple as they had no money left to pay. Now that would be a perfectly reasonable assumption to make. Trusts get paid for activity, things like hernia repairs, aneurysm repairs, cardiac stenting, the kinds of things that you do to make patients get better. As far as I know the NHS tariff system through which the trusts get paid does not include things like deaths or complications.
But in-hospital
deaths are very costly; in-hospital complications are very costly.
There is no mechanism for payment for that. So a hospital/trust which
has high deaths and complications will obviously not have money to do
anything else.
Well, it therefore might
turn out that their inability to pay higher wages had no a financial
reason at all; it may well be a by product of poor quality. High cost,
deficits, losses are all a function of poor quality.
If you pushed them
they will come out with something like ‘in this financial climate
we would like to channel all our sparse finances directly into
patient care’ and you know what, they sure do; their patient care must cost excessive amounts of money due to higher rates of standardised
mortality and higher complications.
Cultural reasons?
Perhaps they were unwilling to pay higher rates; management might not have felt the need to 'reward' staff who are unable to produce high quality measured in terms of mortality. Another reason might have been that the money might be better spent in a high mortality hospital in trying to reduce the mortality rather than paying more to staff when the law does not demand that you do so. These are a part of the mental make up and cultural reasons of management. They are right, well, partly right. It is also just possible that well rewarded staff might be motivated to engage in improvement. Works both ways but always difficult to decide which one is right for the given circumstances.
Finally, here is
some speculation
But, why did some
high mortality hospitals pay staff bank holiday wages? Surely the
above arguments apply to them as well. Why did some low mortality
hospitals not pay higher bank holiday wages?
Now I am moving into
speculation something which I try not to do too often. My gut feeling
is that the high mortality hospitals who paid a higher wage are
probably going to find reduced mortality soon or at the best they may
continue to stay where they without slipping and getting any worse
and the low mortality hospitals who did not pay may find their
mortality going up or at the best they may stay where they are
without getting any better
My speculation is an
extension of my theory about money in hospitals, the trusts who are
doing clinically well might have the spare cash to spend it on staff. If
that was indeed the case, the staff deserve it.
