11 de febr. 2018

Alan Maynard arrived at York when I was born

Alan Maynard was the greatest influencer in the field of health economics.

Alan arrived at York as a graduate student in economics in 1967, when I was born. In 1978 he created York’s MSc in health economics, and in 1983 he founded the Centre for Health Economics (CHE), where he was Director until 1995. CHE has had a major influence on health policy and the development of health economics, and continues to flourish.

He was founding editor of Health Economics, now a leading journal in the field, and later had a hand in creating two other thriving institutions: the York Health Economics Consortium and the Centre for Reviews and Dissemination.

Maynard matters. Critical thinking on health policy
This edited volume is a book with two parts:

Part One of the book consists of a set of short pieces written by Alan’s colleagues, celebrating his contributions to different areas of academic and public life. Part Two contains a selection of Alan’s work.
As Tony Culyer says you will meet seven Maynards in these pages:

  1. The health economics pioneer: cost-effectiveness studies, health service inequalities and economics of mental health, an analytical approach to health service design and management.
  2. The high class journalist: Innumerable think pieces in the Health Service Journal. Often scathing, often ironic, often right, NEVER dull.
  3. The high class academic: Founding editor of a great journal: Health Economics.
  4. The policy wonk: His impact on family doctor fund-holding, the creation of NICE, workforce contracting.
  5. The academic manager: Founding director of the Centre for Health Economics
  6. The teacher: Insightful, amusing (often hilarious) but wise and caring too. Never without a box of Kleenex for those who found the going tough.
  7. The NHS chair: York Hospital NHS Foundation Trust for 12 years, Vale of York NHS Commissioning Group 2012-15.

photos: York daffodils. Heslington Hall by W. Monkhouse (1860)

22 de des. 2017

hospital performance and managerial education

Managerial Education and Management in Healthcare (2017). In this article Nicholas Bloom et al investigate the link between hospital performance and managerial education by collecting a large database of management practices and skills in 2000 hospitals across nine countries.

They document:
  • A large variation of management practices within each country
  • The index “better management” is positively associated with improved clinical outcomes such as survival rates from AMI.
  • There's evidence that a hospital’s proximity to a university which supplies joint business and clinical education is associated with a higher management practice score (and better clinical outcomes).
  • The bundle of managerial and clinical skills has an impact on hospital management quality.
  • Management matters for hospital performance and that the supply of managerial human capital may be a way of improving hospital productivity.
  • Given the enormous pressure health systems are under, this may be a complementary way of dealing with health demands in addition to the usual recipe of greater medical inputs.

The correlations they describe are only suggestive as they do not have panel data or experimental evidence to track out causal impacts. Such evidence from either randomized control trials or natural experiments is an obvious next step in their agenda.

painting: Blue star (2016)

12 de nov. 2017

Ideas are becoming more expensive to find.

In Are Ideas Getting Harder to Find? (NBER Working Paper No. 23782), Nicholas Bloom, Charles I. Jones, John Van Reenen, and Michael Webb argue that, to maintain a given rate of economic growth, resources devoted to research must increase over time.

In many growth models, economic growth arises from people creating ideas, and the long-run growth rate is the product of two terms: the effective number of researchers and their research productivity.

The authors present a wide range of evidence from various industries, products, and firms showing that research effort is rising substantially while research productivity is declining sharply. They cite both aggregate evidence and measures of R&D productivity in specific industries, in particular computers, agriculture, and medicine.

A good example is Moore’s Law. The number of researchers required today to achieve the famous doubling every two years of the density of computer chips is more than 18 times larger than the number required in the early 1970s. Across a broad range of case studies at various levels of (dis)aggregation, they find that ideas — and in particular the exponential growth they imply — are getting harder and harder to find. Exponential growth results from the large increases in research effort that offset its declining productivity.

They argue that a single-minded focus on the quantity of undiscovered ideas is unhelpful. It is not just how many ideas for productivity growth are left, but what it would cost to get them out of the ground – and, crucially, how much we’re prepared to spend to do it. For a long time, geologists have been forecasting ‘peak oil’, only to be surprised by new deep-sea discoveries and shale oil. We, likewise, see a continuing stream of innovations. But, just as newer oil sources are increasingly costly to extract, coming up with new ideas is getting more expensive. There have been technological improvements, but these require the devotion of ever-growing amounts of resources to the research process to maintain steady rates of improvement

These days, pushing the frontier of knowledge out requires mastering an ever-larger body of knowledge, meaning that students have to stay longer in university, and researchers increasingly work in larger teams whose members are more specialised. This all pushes up costs. Returning to the oil metaphor, we are digging deeper into a trickier part of the rock.

Access to the article (pdf): Are Ideas Getting Harder to Find?
Commentary from the authors: Ideas aren’t running out, but they are getting more expensive to find

photo: Until our two activists and our members of the Catalonia Cabinet could come back to Catalonia and will be released from jail I'll publish a dark photo.

24 d’oct. 2017

Community resilience

Resilience is defined as the capacity of any dynamic system to anticipate and adapt
successfully to difficulties.
  • Individual resilience is the process of, capacity for, or outcome of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress.
  • Community resilience is the ability of communities to withstand and recover from community stressors as well as to learn from past stressors to strengthen future response and recovery efforts.
What is a community stressor? A community stressor is an event that negatively impacts a community physically, emotionally, or economically. Stressors differ by communities, but examples include:
  • Weather-related disasters (e.g., hurricanes or severe snowstorms)
  • Economic downturns or high poverty rates
  • Gun violence or drug-related crimes
  • Environmental issues (e.g., climate change or global warming)

Two interesting articles
1. A toolkit to teach people about community resilience so that they can then educate others about resilience and resilience building. RAND TOOLKIT COMMUNITY RESILIENCE

2. Spanish paper from Juan de Dios Uriarte Arciniega (Universidad Pais Vasco and Ex-director Academia de la Ertzaintza). LA PERSPECTIVA COMUNITARIA DE LA RESILIENCIA

I think Catalan and Spanish people are not prepared to the adverse effects that they will occur soon and they have not been doing anything to build a community resilience.
Me as an individual also I'm not prepared. I'm afraid.

(*) Photosolde: Les parque __________________________________________________________________

29 de set. 2017

Back to basics: how to manage conflict: shark, owl, fox, turtle or teddy bear?

In any Conflict Situations you may respond in one of these five ways defined by Kenneth W. Thomas and Ralph Kilmann: competitive, collaborative, compromising, avoiding, accommodating.

In such situation, we can describe a person’s behaviour along two basic dimensions: (1) assertiveness, the extent to which the individual attempts to satisfy his own concerns, and (2) cooperativeness, the extent to which the individual attempts to satisfy the other person’s concerns.

These five Conflict Styles are:

  • COMPETITIVE: The shark (Might makes right). Competing is assertiveness and uncooperative- -an individual pursues his own concerns at the other person’s expense. This is power-oriented mode, in which ones uses whatever power seems appropriate to win one’s own position- -“standing up for your rights, defending a position when you believe is correct, or simply trying to win.
disadvantage: relationships damage
  • ACCOMMODATING: The Teddy bear (kill your enemies with kindness). Accommodating is a unassertive and cooperative—the opposite of competing. When accommodating, an individual neglects his own concerns to satisfy the concerns of the other person, there is an element of self-sacrifice in this obeying another person’s order when one would prefer not to, or yielding to another’s point of view.
disadvantage: long term resentments
  • AVOIDING. The Turtle (Leave well enough alone). Avoiding is unassertive and uncooperative—the individual does not immediately pursue his own concerns or those of the other person. He does not address the conflict. Avoiding might take the form of diplomatically sidestepping an issue, postponing an issue until a better time or simply withdrawing from a threatening situation.
disadvantage: long term resentments
  • COLLABORATIVE. The owl (Two heads are better than one). Collaborating is both assertive and cooperative—the opposite of avoiding. Collaborating involves an attempt to work with the other person to find so me solution which fully satisfies the concerns of both persons. It means digging into an issue to identify the underlying concerns of the two individuals and to find an alternative which meets both sets of concerns. Collaborating between two persons might take the form of exploring a disagreement to learn from each other’s insights, concluding to resolve some condition which would otherwise have them competing for resources, or confronting and trying to find a creative solution to an interpersonal problem.
disadvantage: time and difficulty. Possible need an outside facilitator.
  • COMPROMISING. The fox (Split the difference). Compromising is intermediate in both assertiveness and cooperativeness. The objective is to find some expedient, mutually acceptable solution which partially satisfies both parties. It falls on a middle ground between competing and accommodating. Compromising gives up more than competing but less than accommodating. Likewise, it addresses an issue more directly than avoiding, but doesn’t explore it in as much depth as collaborating. Compromising might mean splitting the difference, exchanging concessions or seeking a quick middle-ground position.
disadvantage: optimal solution missed

photo: (*) Photosolde

17 de set. 2017

Tips for charity leaders

The king's fund in their work with charities wants to highlight some of the most common challenges they face in leadership: They share a short report with 10 tips for charity leaders

1. Take time to reflect and learn: a necessity not a luxury
TIP: Leaders need time to reflect on the organisation’s work, to examine their leadership styles, to learn new ways of working, and to receive support. In such a challenging environment for charities, it’s more important than ever to not see this as a luxury.

2. Build strong relationships with your board
TIP: Analyse the relationships between you and your board; make sure your organisation examines board skills and leadership and has a critical eye on trustee roles. Surfacing these issues are the first steps towards making positive change.

3.Your trustees' report should offer a full picture
TIP: The trustees’ report should not just be left to the finance manager and treasurer; it is worth investing time and effort in producing a full and accurate reflection of your organisation.

4. Present and analyse your data carefully
TIP: Invest time in pulling your data together, being clear on the difference between your activities and your impact and in articulating your value. Provide a good narrative, including how you are responding to the findings, that will make sense to those outside your organisation.

5. Weigh up the opportunities and risks of partnerships
TIP: Carefully weigh up the opportunities and risks of partnership work – both of taking part and of not taking part, there are pros and cons for each. Small organisations can easily be sidelined in partnership working, so be assertive when negotiating terms and articulating the distinctive value you bring, and make sure you are clear on areas such as budgets, quality, responsibility and risk.

6. Manage capacity and demand to ensure sustainability
TIP: Give yourself time to ‘think outside the box’ and be entrepreneurial; face up to tough decisions and change and make sure you keep abreast of new opportunities. Look after yourself and your staff to minimise stress, and don’t be afraid of saying no to new services, particularly if you can’t afford to run them.

7. Don't ignore succession planning and empowering teams
TIP: A more distributed approach to leadership across an organisation, where different staff can represent and carry out key tasks for the charity, receiving training and development to do so, will make organisations more resilient.

8. Ask if you don't know the answer
TIP: Don’t be afraid to get help if you need it – it will reduce the pressures of leadership but could also be an organisational risk if you don’t.

9. Produce engaging funding applications
TIP: If you can, try to get someone who is not as close to the work to read and sense-check funding applications before they are submitted. If you can’t do that, consider honestly whether your application would stand out if it was the 30th or even 100th one you had read.

10. Don't bury your head in the sand if the money is running out
TIP: You will have a better chance of solving any funding problems if you predict them well in advance and explore your options carefully. Keep trying to diversify income – difficult but important, and tell your funders as early as possible if you think you will have a problem; they may be able to renegotiate with you or reschedule payments to help see you through.

photo: (*) Photosolde
Petita ofrena floral als refugiats


1 d’ag. 2017

Boards: when a nonprofit needs to make tough decisions, do you have the right brains in the room?

The 'Nine steps' publication and supporting material is the third edition published to help sport and not-for-profit organisations from New Zealand to improve governance structures and processes. Its supported by Sport New Zealand
Web access with support material to download: Nine steps to effective governance - building high-performing organisations
Here I would like to focus on Board Needs. My experience reveals the importance of having a knowledgeable and engaged board, a board that understands its fiduciary role, its managerial role and depending on the type of institution its fundraising role. Boards members should have:

EXPERTISE: knowledge, skills, and experience
The initial challenge is to determine what relevant knowledge, skills and experience the board needs. The degree to which particular sets of knowledge, skills and experience might be required will depend on the business of the organisation, the challenges facing it and its specific current and prospective circumstances.
  • It is preferable that all candidates will have some degree of governance experience and a basic understanding of board work.
  • It is important for a board to include people who can understand: 1) an organisation's culture and what motivates the behaviour of those within it; 2) the economic drivers of its performance; 3) where its best growth opportunities lie; and the risks that it faces.
  • Focus on what people will DO rather than what people ARE
  • Emphasize diversity and demographic characteristics like gender, sexual identity, disability, age and geographical variables like nationality or location of residence..
A second important selection factor is the set of attributes that relates to a person's ability to contribute and collaborate in a group decision-making context. Without personal attributes that assist an individual's knowledge, skills and experience to be taken up by the board, he or she is unlikely to add value as a member of the board.
  • Independence - free to think for themselves
  • Intelligence - ability to understand and be critically analytical
  • Moral compass and integrity
  • Good judgement and personal confidence -ability and courage to raise difficult issues
  • Emotional intelligence - manage their egos, respect and be able to understand the needs and feelings of others
  • Open mindedness and ability to challenge their decisions
  • Outcome-oriented - more interested in impact than in process
  • Motivation - they want to join the board for the right reasons 
photo: (*) Photosolde