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SAMJ: South African Medical Journal

versão On-line ISSN 2078-5135
versão impressa ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.108 no.7 Cape Town Jul. 2018

 

IZINDABA

 

High Performance in Hospital Management: A Guideline for Developing and Developed Countries

 

 

 

By Edda Weimann and Peter Weimann.
Berlin: Springer Publishing Company, 2017.
ISBN: 978-3-662-49658-9
ISBN (e-book): 978-3-662-49660-2

 

High Performance in Hospital Management: A Guideline for Developing and Developed Countries

I recently had the pleasure of reading Prof. Edda and Prof. Peter Weimann's excellent book High Performance in Hospital Management: A Guideline for Developing and Developed Countries, which makes a very important contribution to management practice.

The book covers an incredibly wide range of topics in an accessible and highly readable way. It is an exceptionally useful resource, even for those of us who have no direct involvement in healthcare. Let me briefly discuss just six of the ways in which the book contributes to the wider debates within our society. Specifically, I will focus on what the book contributes to the discussion in South Africa (SA) and other developing countries about the need to work towards universal healthcare.

First, the book articulates cogent arguments around universal health coverage as a basic right towards which we need to strive. Universal health coverage improves health, but it also reduces poverty, creates jobs, drives economic growth and promotes gender equality. It takes vision, commitment and long-term thinking.

Second, healthcare is an investment rather than a consumption good. The authors estimate that National Health Insurance (NHI) in SA could reduce the burden of disease by 14.2 million disability-adjusted life years and save 184 085 lives (by avoiding premature death), but then - rightly - qualify that by saying that this will only happen if service provision, equity and efficiency are improved. This book fills a much-needed gap in terms of setting out in a clear way how those efficiencies can be achieved.

Third, an NHI scheme will fail if the country's public hospitals continue to function as badly as many of them currently do. Mismanagement and poor services are the norm at many of SA's government medical facilities. The country's beleaguered public health system will have to improve drastically for NHI to be properly implemented. It is evident that we currently have public health expenditure with bad outcomes; raising more money for healthcare will not guarantee that health outcomes will improve. The real problem is the administration of that service. This is, of course, exactly what makes the contribution so important - the whole book is about how to improve the management of health services.

Fourth, the book emphasises the critical importance of accountability and good governance. It is clear that the present lack of accountability for the mismanagement of state medical facilities is a huge problem. The book sets out ways to increase accountability, such as through hospital trusts with a board of directors that consists of members of the public. The board holds the hospital accountable for its services, which can make a huge difference in the efficiency of hospitals.

Fifth, there is currently a lack of autonomy among state hospital chiefs, especially with regard to managing staff and supplies. The heads of large state hospitals have little authority to make real decisions over critical management issues. Because of this, government health institutions are not being run as efficiently as they could be. State hospital chief executives have little say in the hiring and firing of staff or the purchasing of new equipment. Something as small as allowing state hospital chief executives to directly manage repairs could significantly improve service delivery.

Sixth, there is a great need to collect data on the management of patients at state hospitals. These data would tell us how successfully, or unsuccessfully, a hospital handles its patients and what could be done differently. At present the system does not keep track of a patient's journey through a hospital, and we do not even know how many patients are transferred between hospital departments. This is where the innovations of those with expertise in information systems can play a critical role in helping to design management information systems.

It is clear that delivering high-quality healthcare is not an issue that healthcare professionals can address on their own. The contributions of economists, accountants, organisational psychologists and management consultants are critical to the design of health systems, the financing of the healthcare system and the delivery of high-quality, efficient services. This book sets out myriad ways in which all disciplines can start to contribute. I highly recommend it.

 

Ingrid Woolard

Dean of the Faculty of Economic and Management Sciences, Stellenbosch University, South Africa. ingridw@sun.ac.za

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