Privatization of a public hospital: a quality improvement strategy.

Public hospitals face mounting challenges posed by the rise of managed care, increasing hospital competition, growing responsibilities in indigent care, and stagnant public sector revenues. Privatization exists as a viable strategy for reengineering the structure and operation of public hospitals to meet the new demands of quality and efficiency imposed by a rapidly changing health care environment.

Consumer participation and social accountability.

Consumer participation in the planning and management of health care programs is prescribed as a method for increasing provider responsiveness to the goals and needs of users of services. However, issues related to the nature of mandates to implement consumer participation has not had the impact on policy development proposed for it. While structural changes can be identified which might enhance the consumer role in decision making, it will also be necessary for the consumer sector to develop a strategy which will prompt major rather than incremental movement.

The impact of training on consumer participation in the delivery of health services.

A retrospective evaluation of training provided to six hospital consumer advisory groups is described. The training program was designed to provide information and decision-making skills to consumers of services and community representatives serving on voluntary hospital advisory boards. The evaluation, initiated after the end of the training program, demonstrates different effects of training depending on the stage of development of the consumer board. All but one of the six boards studied showed positive changes in the number and type of activities following training.

A conceptual framework for emergency care planning.

The experience of functional program planning, in addition to facilitating the planning process for a new emergency unit, has had additional benefits. It has given the staff a common conceptual framework for analyzing patient care as provided and for identifying areas where improvements can be made. Also, a new approach has been developed for communicating with other departments and with hospital administration about day-to-day operating problems which may be useful for addressing other resource allocating and operating room time schedules. By developing a planning framework, it is possible to integrate the expertise of various services, while retaining an integrated overall orientation within which the efficacy of different proposals can be judged. This approach is critically important in helping to avoid the adverse effects of fragmented planning.