title: Managing poorly performing clinicians: health care providers' willingness to pay for independent help.
abstract: OBJECTIVE
  To determine the willingness to pay (WTP) of senior managers in the UK National Health Service (NHS) for services to help manage performance concerns with doctors, dentists and pharmacists.
  
  
  METHODS
  A discrete choice experiment (DCE) was used to elicit senior managers' preferences for a support service to help manage clinical performance concerns. The DCE was based on: a literature review; interviews with support service providers and clinical professional bodies; and discussion groups with managers. From the DCE responses, we estimate marginal WTP for aspects of support services.
  
  
  RESULTS
  451 NHS managers completed the DCE questionnaire. NHS managers are willing to pay for: advice, 'facilitation', and behavioural, health, clinical and organisational assessments. Telephone advice with written confirmation was valued most highly. NHS managers were willing to pay £161.56 (CI: £160.81-£162.32) per year per whole time equivalent doctor, dentist or pharmacist, for support to help manage clinical performance concerns. Marginal WTP varied across respondent subgroups but was always positive.
  
  
  CONCLUSIONS
  Health care managers valued help in managing the clinicians' performance, and were willing to pay for it from their organisations' limited funds. Their WTP exceeds the current cost of a UK body providing similar support. Establishing a central body to provide such services across a health care system, with the associated economies of scale including cumulative experience, is an option that policy makers should consider seriously.
authors.affiliation: Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK. v.watson@abdn.ac.uk
authors.forename: Verity
authors.initials: V
authors.lastname: Watson
authors.forename: Jon
authors.initials: J
authors.lastname: Sussex
authors.forename: Mandy
authors.initials: M
authors.lastname: Ryan
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Tetteh
mesh_terms: D002983:Clinical Competence; D006282:Health Personnel / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training / Q000191:economics*; D013192:Staff Development / Q000191:economics*; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom