It was Oscar Wilde who warned against ‘men who know the price of everything but the value of nothing’. Although he wasn't referring to healthcare economists, he easily might have been! Fortunately, in his recent book, William Bryans has shown himself to be adept at applying economic concepts in a way that makes clear their reliance upon values of equity and quality. As such, his book is an interesting and useful primer in management issues which will be of particular interest to clinicians becoming more heavily involved in the field.
Bryans' book is wide ranging in its attempt to apply economic and management concepts to everyday NHS life. The topics covered range from the macro-funding of the NHS to detailed advice on budget management at the departmental level. The book's stated aim is to have ‘an emphasis on the practical and what to do next’ and it strives hard to live up to this laudable goal. Some aspects seem a little out of date despite being so recently published. For example, it talks about long trolley waits, which are almost a thing of the past in the majority of accident and emergency departments.
In the main, however, it provides relevant and interesting information for the informed reader on the relationships between quality, public expectations and costs. The challenges of managing within tight resource limits and the difficult human relations and organisational political issues involved in managing to a budget are well brought out. The book sets out to provide a bridge between principles and practice and its use of mini case studies to achieve this is both informative and entertaining. Indeed, many will empathise with Mr H O'Chondriac who was admitted to St Beadful Hospital. Unfortunately, however, it never quite achieves its stated ambition of delivering every budget manager's dream – ‘how to make significant savings from already overstretched resources’.
It is somewhat surprising that there is little on the most recent evidence-based approaches to quality improvement such as total quality management, six sigma or lean thinking. These disciplines have been shown in other sectors and in some limited places in healthcare to deliver improved quality at lower costs. Given the book's stated aim, it would have been helpful for there to have been greater reference to such approaches. In view of its somewhat eclectic mix of concepts and issues, this may also have given a clearer overall structure.
Nevertheless, Bryans has produced a useful introduction for clinicians who are new to the management of budgets. He has shown that there are no easy answers and has made clear that developing the skills of managing resources well – be they money, buildings, equipment or people – is critical to the delivery of good quality care for patients.