Abstract

1. HISTORY. The program began in 1986 as the Resource Management Initiative and had just six pilot sites. In 1989, Ministers decided to establish a national Resource Management Programme covering all general acute Hospitals in England with more than 250 beds--some 250-260 sites in all. A range of community units also embarked on a program of pilot projects aimed at testing the RM principles in those services. 2. ELEMENTS OF THE PROGRAM. A site joining the program was expected to submit a case based on readiness for inclusion, supported by an outline project plan before approval could be given. The plan encompassed a range of elements, but was individual to each unit; the philosophy being that each unit was being assisted to reach its own objectives within an overall framework. The elements of the framework were as follows: a) A vision of what was expected to be achieved by the project and the benefits being sought; b) A focus on improving the quality of patient care in the unit; c) Involving clinicians in the management process; d) The availability of clinical information to support decision-making; this included the hardware and software for Case-Mix Management and Nurse Management Systems, but also extended to coding, classifying, and grouping systems. e) A greater awareness of the financial implications of clinical decisions; f) A project management approach to implementation; g) An approach based on developing both the organization and its staff, with training. 3. THE KEY TO RM IMPLEMENTATION IS CULTURAL CHANGE AT THE UNIT LEVEL. While steps to achieve this change can be planned and driven forward via the project plan, the very nature of the project means that a more flexible and "soft systems" view of success is appropriate. Local ownership of the process is essential and can lead to a very specific view of "success." 4. BENEFITS. Demonstrating primary causality is difficult as eight years have elapsed since the program was started, and this has coincided with a period of radical change. However certain matters are beyond dispute: The vast majority of units have adopted one form or other of Clinical Directorate structure. Many clinical staff are formally engaged in the operational and general management process. Some RM sites are advantageous when it comes to negotiating with their purchaser organizations because they have better quality data on which to base the process. The use of Casemix Management and Nurse Management Systems is seen in some RM sites as improving the quality of patient care provided. RM has focused attention on clinical coding and grouping. RM has exposed the need to develop or reassess Information Strategies at unit level. RM has stimulated staff training and development at site level and has been instrumental in improving the quality of training facilities, resources, and materials that are available. RM is recognized as having had a catalytic effect on changes associated with the NHS Reforms. 5. CONCLUSION. Good quality services require well-managed and competent provider organizations. The RM program was designed to assist the improvement of provider unit management. There is general agreement that the principles of RM should be taken forward in the broader context of provider development, with a focus on quality as well as financial issues.