Managing Poorly Performing Clinicians: The Value of Independent Help

Objective: To value services that help organisations to manage performance concerns with doctors, dentists or pharmacists. Methods: Qualitative and quantitative methods. Qualitative analysis consists of: a literature review; interviews with support service providers and clinical professional bodies; and discussion groups with managers who deal with clinical performance concerns in UK National Health Service (NHS) organisations. Quantitative analysis applied a discrete choice experiment (DCE) questionnaire to explore senior NHS managers’ preferences for support when dealing with clinical performance concerns. From the DCE responses we estimate the marginal willingness to pay for aspects of support services. Results: Nine interviews and four discussion groups (23 participants) were conducted. 451 NHS managers completed and returned the DCE questionnaire. NHS managers value: advice on procedures and laws, ‘facilitation’ (mediation of meetings, help with action plans and monitoring of these), behavioural, health, clinical and organisational assessments, when managing clinical assessment concerns. Among the support services potentially available, telephone advice with written confirmation was valued most highly, followed by full clinical and organisational assessment. NHS managers thought their organisations should be willing to pay £161.56 (CI: £160.81 to £162.32) per year per whole time equivalent doctor, dentist or pharmacist covered, for a package of support services that helps them manage clinical performance concerns. Marginal willingness to pay for support varied across subgroups of respondents but was always positive. Conclusions: Health care managers valued independent help in managing the performance of clinicians. That valuation exceeds the current cost of a UK body providing similar support.