Constraints on innovatory practice: the case of day surgery in the NHS.

Rates of adoption of new technology or innovatory practices depend upon their inherent managerial and clinical incentives. Rates will be highest where these incentives coincide and lowest where both are weak. Within this framework we examine the current low rate of adoption of day surgery in the National Health Service (NHS) of the United Kingdom (UK). We assess the current managerial incentives for the introduction of day surgery in terms of its potential either to achieve financial savings or to allow expansions in overall hospital caseload. These are both shown to have been low within the context of the traditional method of funding health care in the NHS. Clinical attitudes and their perceptions of the barriers to day surgery are examined based on data from a survey of 240 consultant surgeons. A high proportion of surgeons regard day surgery as clinically acceptable for a wide range of procedures, but the limited clinical appeal of day surgery procedures and the lack of day facilities have further limited its adoption. These findings are considered in the context of the revised methods of funding hospital services in NHS, introduced from April 1991. Priorities may change with managerial incentives playing a greater role in the introduction of new technologies and innovatory practices.