Do consultants treat humans or make widgets?
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2012)

Productivity was once a word at the centre of disputes between factory workers and owners. Owners wanted more widgets for lower cost. Factory workers preferred the status quo in widget production. Little has changed in the world of business. But each dip of economic recession intensifies workplace discussions about redundancies and salary sacrifices. The owners or managers of any commercial organisation want even more for much less. Reduce costs, improve productivity. The status quo, though, is dead. Change or you are toast.

Once doctors watched from a lofty height; a secure job for life, a stable profession with guaranteed earnings and few questions asked. A career in medicine, for many doctors, still offers a smooth trajectory of promotion and income. But when Her Majesty's Treasury raids the National Health Service for £3 billion, the game has changed.1 Productivity, a word that inflames any dispute, has become a common measure of health systems and the people who work in them.

Salary rises awarded to both hospital doctors and GPs in the last decade, at a time when the productivity of the NHS continued to fall year on year, has sharpened focus on the level and quality of service being delivered. The new consultant contract, introduced in 2003, offered more money—salaries increased by 27% between 2003 and 2006—in exchange for the potential to manage consultants’ activity.

Productivity wasn't explicitly linked to better pay explain Karen Bloor and colleagues, but the government's business case for the new contract carried an expectation of year-on-year consultant productivity gains of 1.5%.2 Their analysis covering 1999 to 2009 reveals that although several quality measures have improved, consultant productivity hasn't—and in half the specialties studied, productivity decreased.

In our uncertain times of recession, days of working harder to stand still, these productivity data will be difficult for hospital consultants to accept. Indeed, the ‘input’ side of the analysis isn't solely dependent on salary. For example, staffing levels in the NHS have increased. Many consultants will also argue that the contract restored salary to an appropriate level.

But the message of this new study is a broader one than mere consultant bashing. Improvements in healthcare productivity sound attractive in discussions and projections. The difficulty with productivity targets, just like efficiency gains, is delivering them. In a rapidly evolving environment like any national health service, they become harder to achieve, potentially impossible, as the complexities of healthcare continue to multiply year-on-year.

Perhaps, in an age that is as much of decadence as it is of recession, slowing decline in healthcare productivity is as good as it gets? Perhaps healthcare productivity is immune to the engineering process improvements promoted by management consultants that can succeed in a widget factory? Perhaps we need to ask a more fundamental question, to misquote American Indie rock band The Killers, are we human or are we widget?