预算管理英文原文与中文译文.docx

预算管理英文原文与中文译文.docx

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预算管理英文原文与中文译文

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,networkedcompa