Utility theory and its use in managerial systems : an NHS perspective
2015-02-11T16:01:17Z (GMT) by
This thesis originated from a research question created by a focus group of National Health Service (NHS) senior estates managers, who considered that the systems of internal control do not give adequate assurance that NHS healthcare building services engineering day-to-day maintenance activities conform to the national guidance. The initial aim of this research was to test their concerns against empirical evidence from NHS Trusts. This was achieved by identifying the gaps within the participating Trusts' maintenance managerial activities when assessed against national standards. Central to the methodology used to assess the level of dynamic risk being generated was the rejection of the NHS national standard 5x5 risk criticality grid in common use throughout the health service, in favour of a series of specific 'Utility Functions'. This has created greater transparency and robustness of the risk assessment process. To the researcher's knowledge, this is the first time that 'Utility Theory' has been used in such scenarios. The result of this analysis has shown their fear to be correct. And for each of the 31 NHS Trusts taking part, the multi-professional focus groups composed of their own senior managers confirmed that there are areas of non-conformance within their maintenance regime, which were previously unknown. In all cases the organisations considered that their failings were exposing their patients, staff, public and stakeholders to substantial/intolerable risk through a 'systematic' failure of the Trusts' governance systems. The aim of this research then expanded to design techniques that specifically assesses the resource needs to close these managerial gaps employing industry standard techniques. Then again employing 'Utility Theory' examined various revenue levels of directly employed maintenance artisan resource with respect to risk, via a specifically designed simulation model. This has proved that the historical NHS methodology for assessing workforce planning to be fundamentally flawed, as it seriously underestimates the resource need. This research then developed and designed a generic day-to-day monitoring assurance framework from reference to the research into High Reliability Organisations, Normal Accident Theory and managerial governance needs. The overriding recommendation from the research was that NHS Trusts must redesign their governance systems to ensure that they are aware of their estates department's non-conformances when assessed against national standards.