- Competition: having 10 or more choices available to patients predicted better management practices, which in turn correlated well with survival from heart attack (a standardised measure of hospital success)
- Larger size: bigger hospitals performed better than smaller ones
- Private ownership: higher scores
- Clinicians in managerial roles is good: the UK is relatively poor with only 58% of managers having a clinical background. In Italy, all managers must have clinical backgrounds, in Sweden it’s 93%; US, Canada and Germany, 71-74%; France, 64%.
- Managers given autonomy fare best.
These findings appear to correlate in the NHS. The Hammersmith Hospital in London is considered one of the best in the country and fulfils most of the criteria. “Big, professional, autonomous, mostly independent and ferociously competitive: elite universities seem to offer all five important characteristics for saving lives.”