预算管理.docx
《预算管理.docx》由会员分享,可在线阅读,更多相关《预算管理.docx(12页珍藏版)》请在冰点文库上搜索。
预算管理
英文原文
Budgetmanagement
1Introduction
TheNHSreformshavehadfarreachingimplicationsforcliniciansofallgradesandspecialties.Amongotherchanges,ithasbeendeliberategovernmentpolicythatseniorcliniciansshouldhavemoredirectmanagementandbudgetaryresponsibilitywithintheirownclinicalareas.Trusthospitalshavedevelopedadirectoratebasedmanagementstructureanddevolvedbudgetstoclinicaldirectors.A&Edepartmentshaveeitherbecomedirectoratesintheirownrightorassociatedirectorateswithinlargerdirectorates.A&Econsultantswhotakeonclinicaldirectorshipresponsibilitieswillhavemoredirectcontrolofspendingwithintheirowndepartment.Atfirstthismayseemintimidating,buttheadvantagesofhavingcontroloutweighthedisadvantagesofmoreadministrativeactivity.
Thisarticleaimstogivesomeguidelinestohelpmakethetasklessdaunting,aswellassometipsbasedonpersonalexperience.Idonotintendtocoverfundraisingactivityortheorganizationofpostgraduateeducationanditsfunding.Briefmentionwillbemadeof"businessplanning"attheend.Andwehaveoutlinedwhatmanagementbudgetingisandhowitdiffersfromtraditionalbudgetarycontrolsystemsinhealthauthorities;consideredwhatitaimstoachieve;anddiscussedtheparticipationofcliniciansinthemanagementbudgetingprocessanditslikelyimpactontheirmethodsofworking.
2Whatisabudget?
Traditionalbudgetarycontrolsystemsarebasedprimarilyonastructureofwhatarenormallytermedfunctionalordepartmentalbudgets.Inthisstructurebudgetsareheldbythosepeopleresponsibleforprovidingaservice.
Thereisnormallynoparticipationofclinicalstaffinthisbudgetarycontrolstructureotherthanthepossibilitythatthebudgetholdersforpathologyandradiologymightbetheconsultantsincharge.Thisseemsstrangegiventheconsiderableinfluencethatclinicianshaveovertheuseofhospitalresources.
Inanysystemofbudgetarycontrolakeyprincipleisthatindividualbudgetholdersshouldbeheldresponsibleonlyforthoseitemsofexpenditureoverwhichtheycanexertcontrol.Inhealthauthoritiesthisprincipledoesnotalwaysapply.Anextremeexampleofthisconcernsthepharmacybudget,wherethepharmacistisoftenheldresponsiblefordrugsexpenditureeventhoughhehasnodirectcontroloverthelevelofspending.
Althoughabudgetisasumofmoneygiventoyoutorunyourservice(includingsalariesandwagesofallpersonnel)itisimportanttorealizeitisessentiallyapaperexercisesimilartorunningyourownbankaccountandreceivingabankstatement.Youwillneveractuallyseethemoneyandthenitty-grittyofmanipulatingtheaccountisdonebyyourmanagementcolleaguesandthefinancedepartment.Yourroleasclinicaldirectoristokeepawatchingbriefonitandtomakeexecutivedecisionsastohowitisspent.Therearethreebroadcategoriesofbudget:
(1)Steadystate-youareallocatedthesameamountofmoneyeachyearwithanallowanceforinflation.Althoughitofferspredictabilityforfutureplanningitisinflexibleanddoesnotallowforsurgesinactivityorunfundedgovernmentandtrustleadinitiatives.ThemajorityofA&Edepartmentsreceivetheirfundinginthisway.
(2)Activitybased-theamountofmoneyprovidedreflectstheworkdone.Itisaccurate,flexible,andisthebasisofmuchpurchaser/providercontractactivity.Itisgenerallynotavailableuntiltheworkhasbeencompletedandwillvaryfromyeartoyear.
(3)Lumpsum-thegovernment,region,ortrustreleasesalumpsumofmoneyforaspecificpurpose(forexample,tostarttriageorauditortocompleteawaitinglistinitiative).Thisisunpredictable,oftencomesatshortnotice,andcanrarelybeusedforlongtermplanning.
AlthoughthemajorityofA&Ebudgetingfallsintothefirstcategory,lumpsummoneyisavailablefromtimetotime.Anaveragedepartmentseeing50000patientsayearmayhadeanannualbudgetofapproximatelyonemillionpounds.Whentakingonabudgetaskthesequestions:
(1)Howbigisit?
Whoactuallycontrolsit?
(2)Doyoureallyhavecontrolofitorisitonlytheoretical,Howoftenwillyoureceiveastatement?
Whodoyouspeaktomakechangeswiththebudget?
Withwhomandhowdoyounegotiatewithinyourinstitution?
(3)Asktobetakenthroughabudgetstatementandhaveaclearexplanationofallterms,etc.Itisnormallydeliveredmonthlyandalthoughitmaylookcomplicateditiseasytomasterandisreallylittledifferentfromyourownbankstatement.
(4)Gothroughitcarefullyasmistakesareanoccasionaloccurrence(althoughtheycanberectifiedretrospectivethroughthefinancedepartment).
(5)ThefinancialyearrunsfromApriltoMarch.Thetheoreticalaimistomakethebooksbalancebytheendofthefinancialyearandnotfrommonthtomonth.Shorttermoverspendsorunderspendsarenotimportant.
(6)Apositive(+)signmeansanoverspendandanegative(-)signmeansanunderspend.
(7)Concentrateonthebignumbers;donotworrytoomuchaboutlittlenumbersalthoughtheydoneedtoreanalyzedatsomestageassavingscanprobablybemadewithoutaffectingthequalityofservice.
(8)Devolvecontrolofthenursingbudgettoyourclinicalnursemanagerbutbepreparedtoinvolveyourselfinnursingactivities(forexample,thedevelopmentofnursepartitioning).
(9)Bepreparedtonegotiatewithotherdirectoratesaboutcertainitems,similarissuesarisewithfundingforanestheticagentsandbloodproducts.
(10)Usecreativeaccountancy.Thisislegitimateandwillevenreceivethesupportofyourfinancialcolleagues.
Akeyprincipleofmanagementbudgetsisthatallusersofservicesshouldbeinformedoftheircosts.Thisisachievedbymeansofrechargesmadebetweenthosebudgetholderswhosupplyservicesandthosewhousethem.Consideringdomesticandcleaningservicesagain,thiswouldentailarechargebetweenthatdepartment'sbudgetandthoseofotherdepartmentsandfacilitiesinthehospital.Cleaningcostswouldthenappearonbudgetreports.
Inthecaseof,say,pathologyservices,consultantbudgetholderswouldbechargedaccordingtothenumberandtypeofteststhattheyrequest.Suchrechargeswouldbebasedonanagreedpricelistfortestsratherthantheactualcostofperformingeachindividualone.Thiswouldhavetheeffectofprotectingtheconsultantswhousepathologyservicesfrombearingthecostsofanyinefficienciesinthelaboratories.
Itisbeyondthescopeofthisarticletodescribeindetailtherevisedproceduresforsettingbudgetsthatwouldapplyinasystemofmanagementbudgeting.Twofeaturesofimportanceshould,however,benoted.
Thefirstisthatallbudgetholders,includingclinicians,wouldbeinvitedtodiscusspossiblechangesintheirbudgets.Suchdiscussionswouldconsideroptionsforservicedevelopmentsifadditionalresourcesbecameavailableandoptionsforretrenchmentshouldthisbecomenecessaryasaconsequenceofreductionsinresources.Alsoincludedwouldbeanassessmentofalternativewaysofusingexistingresourcestoachievegreaterefficiency.Thesereallocationsmightbemadewithinaspecificbudgetormightmeanthemovementofresourcesfromonebudgettoanother.
Linkedtothesediscussionswouldbeseveralfinancialincentivesintendedtoencouragegoodbudgetarycontrol.Typically,thesewouldpermitbudgetholderstoretainaproportionofanyplannedunderpinningstouseinimprovingtheservicesthattheyprovide.
3WhoNeedsBudgets?
Moderncompaniesrejectcentralization,inflexibleplanning,andcommandandcontrol.Sowhydotheyclingtoaprocessthatreinforcesthosethings?
Budgeting,asmostcorporationspracticeit,shouldbeabolished.Thatmaysoundlikearadicalproposition,butitwouldbemerelytheculminationoflong-runningeffortstotransformorganizationsfromcentralizedhierarchiesintodevolvednetworksthatallowfornimbleadjustmentstomarketconditions.Mostoftheotherbuildingblocksareinplace.CompanieshaveinvestedhugesumsinITnetworks,processreengineering,andarangeofmanagementtoolsincludingEVA(EconomicValueAdded),balancedscorecards,andactivityaccounting.Buttheyhavebeenunabletoestablishaneworderbecausethebudgetandthecommandandcontrolculturethatitsupportsremainpredominant.
Inextremecases,useofthebudgettoforceperformanceimprovementsmayleadtoabreakdownincorporateethics.PeoplewhoworkedatWorldCom,nowbankruptandundercriminalinvestigation,saidCEOBernardEbert’srigiddemandswereanoverwhelmingfactoflifethere.“Youwouldhaveabudget,andhewouldmandatethatyouhadtobe2%underbudget,”saidapersonwhoworkedatWorldCom,accordingtoanarticleinFinancialTimeslastyear.“Nothingelsewasacceptable.”WorldCom,Enron,BaringsBank,andotherfailedcompanieshadtightbudgetarycontrolprocessesthatfunneledinformationonlytothosewitha“needtoknow.”
Inshort,thesamecompaniesthatvowtostayclosetothecustomer,sothattheycanrespondquicklytopreciousintelligenceaboutmarketshifts,clingtenaciouslytobudgeting--aprocessthatdisembowelsthefrontline,discouragesinformationsharing,andslowstheresponsetomarketdevelopmentsuntilit'stoolate.
Anumberofcompanieshaverecognizedthefullextentofthedamagedonebybudgeting.Theyhaverejectedtherelianceonobsoletedataandtheprotracted,self-interestedwranglingoverwhatthedataindicateaboutthefuture.Andtheyhaverejectedtheforegoneconclusionsembeddedintraditionalbudgets--conclusionsthatrenderpointlesstheinterpretationandcirculationofcurrentmarketinformation,thestock-in-tradeoftheknowledge-based,networkedcompany.
4Businessplanning
ThisisanewconceptintheNHSbutiswellrecognizedinprivateindustry.Youwillprobablyb