预算管理(英文原文与中文译文)

2021年1月25日发(作者：haik)
英文原文

Budget management

1 Introduction
The
NHS
reforms
have
had
far
reaching
implications
for
clinicians
of
all
grades and specialties. Among other changes, it has been deliberate government
policy that senior clinicians should have more direct management and budgetary
responsibility
within
their
own
clinical
areas.
Trust
hospitals
have
developed
a
directorate
based
management
structure
and
devolved
budgets
to
clinical
directors. A&E departments have either become directorates in their own right or
associate
directorates
within
larger
directorates.
A&E
consultants
who
take
on
clinical
directorship
responsibilities
will
have
more
direct
control
of
spending
within
their
own
department.
At
first
this
may
seem
intimidating,
but
the
advantages of having control outweigh the disadvantages of more administrative
activity.
This article aims to give some guidelines to help make the task less daunting,
as well as some tips based on personal experience. I do not intend to cover fund
raising
activity
or
the
organization
of
postgraduate
education
and
its
funding.
Brief
mention
will
be
made
of

planning
at
the
end.
And
we
have
outlined
what
management
budgeting
is
and
how
it
differs
from
traditional
budgetary
control
systems
in
health
authorities;
considered
what
it
aims
to
achieve;
and
discussed
the
participation
of
clinicians
in
the
management
budgeting process and its likely impact on their methods of working.
2 What is a budget?
Traditional budgetary control systems are based primarily on a structure of
what
are
normally
termed
functional
or
departmental
budgets.
In
this
structure
budgets are held by those people responsible for providing a service.
There is normally no participation of clinical staff in this budgetary control
structure
other
than
the
possibility
that
the
budget
holders
for
pathology
and
radiology
might
be
the
consultants
in
charge.
This
seems
strange
given
the
considerable influence that clinicians have over the use of hospital resources.
In any system of budgetary control a key principle is that individual budget
holders should be held responsible only for those items of expenditure over which
they can exert control. In health authorities this principle does not always apply.
An extreme example of this concerns the pharmacy budget, where the pharmacist
is
often
held
responsible
for
drugs
expenditure
even
though
he
has
no
direct
control over the level of spending.
Although
a
budget
is
a
sum
of
money
given
to
you
to
run
your
service
(including
salaries
and
wages
of
all
personnel)
it
is
important
to
realize
it
is
essentially
a
paper
exercise
similar
to
running
your
own
bank
account
and
receiving
a
bank
statement.
You
will
never
actually
see
the
money
and
the
nitty-gritty of manipulating the account is done by your management colleagues
and the finance department. Your role as clinical director is to keep a watching
brief on it and to make executive decisions as to how it isspent. There are three
broad categories of budget:
(1) Steady state-you are allocated the same amount of money each year with
an allowance for inflation. Although it offers predictability for future planning it
is
inflexible
and
does
not
allow
for
surges
in
activity
or
unfunded
government
and trust lead initiatives. The majority of A&E departments receive their funding
in this way.
(2) Activity based-the amount of money provided reflects the work done. It
is accurate, flexible, and is the basis of much purchaser/provider contract activity.
It is generally not available until the work has been completed and will vary from
year to year.
(3)
Lump
sum-the
government,
region,
or
trust
releases
a
lump
sum
of
money for a specific purpose (for example, to start triage or audit or to complete a
waiting list initiative).This is unpredictable, often comes at short notice, and can
rarely be used for long term planning.
Although the majority of A&E budgeting falls into the first category, lump
sum money is available from time to time. An average department seeing 50 000
patients a year may hadean annual budget of approximately one million pounds.
When taking on a budget ask these questions:
(1) How big is it? Who actually controls it?
(2) Do you really have control of it or is it only theoretical, How often will
you receive a statement? Who do you speak to
make changes with the budget?
With whom and how do you negotiate within your institution?
(3) Ask to be taken through a budget statement and have a clear explanation
of
all
terms,
etc.
It
is
normally
delivered
monthly
and
although
it
may
look
complicated it is easy to master and is really little different from your own bank
statement.
(4)
Go
through
it
carefully
as
mistakes
are
an
occasional
occurrence
(although they can be rectified retrospective through the finance department).
(5) The financial
year runs
from
April to
March. The theoretical
aim is
to
make the books balance by the end of the financial year and not from month to
month. Short term overspends or under spends are not important.
(6) A positive (+) sign means an overspend and a negative (-)sign means an
under spend.
(7)
Concentrate
on
the
big
numbers;
do
not
worry
too
much
about
little
numbers
although
they
do
need
to
reanalyzed
at
some
stage
as
savings
can
probably be made without affecting the quality of service.
(8) Devolve control of the nursing budget to your clinical nurse manager but
be
prepared
to
involve
yourself
in
nursing
activities
(for
example,
the
development of nurse partitioning).
(9)
Be
prepared
to
negotiate
with
other
directorates
about
certain
items,
similar issues arise with funding for anesthetic agents and blood products.
(10) Use creative accountancy. This is legitimate and will even receive the
support of your financial colleagues.
A key principle of management budgets is that all users of services should
be informed of their costs. This is achieved by means of recharges made between
those budget holders who supply services and those who use them. Considering
domestic and cleaning services again, this would entail a recharge between that
department's budget and those of other departments and facilities in the hospital.
Cleaning costs would then appear on budget reports.
In the case of, say, pathology services, consultant budget holders would be
charged
according
to
the
number
and
type
of
tests
that
they
request.
Such
recharges would be based on an agreed price list for tests rather than the actual
cost of performing each individual one. This would have the effect of protecting
the
consultants
who
use
pathology
services
from
bearing
the
costs
of
any
inefficiencies in the laboratories.
It
is
beyond
the
scope
of
this
article
to
describe
in
detail
the
revised
procedures
for
setting
budgets
that
would
apply
in
a
system
of
management
budgeting. Two features of importance should, however, be noted.
The first is that all budget holders, including clinicians, would be invited to
discuss
possible
changes
in
their
budgets.
Such
discussions
would
consider
options
for
service
developments
if
additional
resources
became
available
and
options
for
retrenchment
should
this
become
necessary
as
a
consequence
of
reductions in resources. Also included would bean assessment of alternative ways
of
using
existing
resources
to
achieve
greater
efficiency.
These
reallocations
might
be
made
within
a
specific
budget
or
might
mean
the
movement
of
resources from one budget to another.
Linked to these discussions would be several financial incentives intended to
encourage good budgetary control. Typically, these would permit budget holders
to
retain
a
proportion
of
any
planned
underpinnings
to
use
in
improving
the
services that they provide.
3 Who Needs Budgets?
Modern companies reject centralization, inflexible planning, and command
and
control.
So
why
do
they
cling
to
a
process
that
reinforces
those
things?
Budgeting, as most corporations practice it, should be abolished. That may sound
like a radical proposition, but it would be merely the culmination of long-running
efforts
to
transform
organizations
from
centralized
hierarchies
into
devolved
networks
that
allow
for
nimble
adjustments
to
market
conditions.
Most
of
the
other
building
blocks
are
in
place.
Companies
have
invested
huge
sums
in
IT
networks,
process
reengineering,
and
a
range
of
management
tools
including
EVA
(Economic
Value
Added),
balanced
scorecards,
and
activity
accounting.
But they have been unable to establish a new order because the budget and the
command and control culture that it supports remain predominant.
In extreme cases, use of the budget to force performance improvements may
lead to a breakdown in corporate ethics. People who worked at WorldCom, now
bankrupt
and
under
criminal
investigation,
said
CEO
Bernard
Ebert
’
s
rigid
demands were an
overwhelming fact of life there. “You would have a budget, and
he
would
mandate
that
you
had
to
be
2%
under
budget,
”
said
a
person
who
worked
at
WorldCom,
according
to
an
article
in
Financial
Times
last
year.
“Nothing
else
was
acceptable.”
WorldCom,

Enron,
Barings
Bank,
and
other
failed companies had tight budgetary control processes that funneled information
only to those with a “need to know
.
”

In short, the same companies that vow to stay close to the customer, so that
they
can
respond
quickly
to
precious
intelligence
about
market
shifts,
cling
tenaciously to budgeting--a process that disembowels the front line, discourages
information sharing, and slows the response to market developments until it's too
late.
A number of companies have recognized the full extent of the damage done
by budgeting. They have rejected the reliance on obsolete data and the protracted,
self- interested wrangling over what the data indicate about the future. And they
have
rejected
the
foregone
conclusions
embedded
in
traditional
budgets--conclusions
that
render
pointless
the
interpretation
and
circulation
of
current
market
information,
the
stock-in-trade
of
the
knowledge- based,
networked company.
4 Business planning
This is a new concept in the NHS but is well recognized in private industry.
You will probably be asked to write on each year, a task which is not as tedious
as it may sound. A good plan will help:
(1) Priorities future activity
(2) Predict financial needs
(3) Develop departmental team spirit
(4)
Convince others of your “vision”
and enlist their cooperation
(5) Give support in times of change and uncertainty.
METHOD:
The following is a useful structure for developing your plan:
(1) Identify all the activity of your department.
(2) Do you wish to stop any activity?
(3) Do you wish to continue any activity unchanged?
(4) Do you wish to continue any activity with minor change?
(5) Is there anything you wish to radically change?
(6)
Is
there
anything
you
wish
to
introduce
which
is
considered
radical
or
innovative?
TIPS:
(1)
Involve
your
medical
and
nursing
colleagues;
many
heads
contribute
many ideas
(2) Use brainstorming
(3) Don't forget to involve your clerical staff-they will seething from a very
different angle and can contribute excellent ideas
(4) Include everything in the first draft (it can be pruned later)
(5) If you think an innovative idea is worth pursuing try not to be put off by
caution keep pursuing it
(6) The actual format of the plan should follow that usedwithin your trust.
5 Summary
The
NHS
as
a
whole
is
constrained
to
operate
with
finite
resources.
Furthermore,

each individual district, as a consequence of the cash limit system,
has a fixed sum of money available to it each year for the provision of services.
These financial facts of life must be recognized by all those who use the service
or work in it. From the point of view of the district they lead to two apparently