Management of health facilities: Hospitals
Hospital autonomy
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Health Sector Reform: Improving Hospital Efficiency
Veronica Walford and Ken Grant, 1998, DFID Resource Centre
Making the case for hospital autonomy: definitions; difference from privatisation; advantages and risks of management autonomy; deciding whether autonomy is appropriate; increasing financial stability of the hospital;
Preparation for increasing autonomy: allocating responsibility; delegation and authority; governing structures; drafting legislation; personnel policies & transition arrangements; financial management systems; communications to staff and the public; preparation of service plans; service agreements and performance measurement ; selection & training of key managers and board members;
Measures to improve efficiency within hospitals: contracting out services or functions; improving procurement and management of drugs, supplies and equipment; clinical unit budgets and management; changing staffing levels and mix; making more efficient use of facilities and shorter patient stays; reducing inappropriate use of drugs, diagnostic tests and health services; performance measurement;
(103 pages, pdf 430kb) -
Understanding Organizational Reforms: The Corporatization of Public Hospitals
pdf, 648kb
April Harding and Alexander S. Preker, 2000, The World Bank
Covers: governance and the changing role of the state; management refprms and funding reforms; budgetary, autonomous, corporate and private organizations - the differences between them in roles, motivation and performance; coherence of reforms to achieve sector objectives; a summary of empirical evidence.
(43 pages) -
Potential Implications of Hospital Autonomy on Human Resources Management. A Thai Case Study
Paibul Suriyawongpaisal, Human Resource Development Journal Vol 3 No. 3, 2000
Covers: definitions, components and degrees of hospital autonomy, governance, management, capital financing and recurrent financing; impact on HR management: deployment, utilization, salaries, training and continuing education. The key questions raised are: whether autonomy creation is a “risk-free” measure; whether autonomy will or can achieve the efficiencies it is touted to resolve; and what the appropriate conditions will be under which the main objectives of Hospital Autonomy may be achieved?
(31 pages, pdf 155kb) -
Country experiences: Ghana, India, Indonesia, Kenya, Malawi, Zimbabwe
International Hospital Federation
Scroll about half way down the webpage to find links to a series of documents on country experiences with Hospital Autonomy
(Website with links to documents) -
Hospital reform in Bulgaria and Estonia: What is rational and what not?
pdf, 400kb
2007, Index (Bulgaria) and Praxis (Estonia)
Both countries have transformed their hospital financing models, moving from a planned budget to financing linked to performed activity, and this is viewed positively. However the insufficient financing of the hospital sector is seen as obstructing the achievement of the main objectives of the health care system: quality, access and financial sustainability.
While the transformation of hospitals into separate juridical entities (trade companies) increases freedom and operational independence, there are concerns about the social functions of the health care system previously fulfilled by hospitals in the absence of alternative provision of longer-term care. Thus, there is feeling of conflict between public interests and hospitals acting under the civil law (as a market entity).
(62 pages)