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Management, not money, key to solving crisis in public hospitals

May 2012: Pouring more money into South Africa’s ailing public healthcare system is not the solution to resolving the current crisis within state hospitals. Rather, in order for the state system to work optimally, it is crucial that the correct management is appointed and that they are empowered to actually run the hospitals.

 

This is according to Graham Anderson, Principal Officer at Profmed, the medical scheme that caters exclusively for graduate professionals, who says one of the biggest challenges currently is that hospital managers are not given autonomy. “Currently all state hospitals fall under the remit of the Department of Public Works (DPW), whilst the running of the facilities is done by the Department of Health (DOH). This creates huge challenges for those who are put in charge of running the hospital. If a boiler blows up, or repairs need to be made to any equipment, then the manager cannot phone the supplier directly, as he has to contact the DPW first.”

 

He says it is positive news that Health Minister, Aaron Motsoaeldi, recently advertised 90 CEO hospital posts to ensure qualified medical and managerial staff are recruited to lead these facilities. “While we do welcome this move, it is critical that the right people are put in the right position. Putting doctors in charge of hospitals is not the correct solution. A good doctor should be doing what he is trained to do, which is treating patients.”

 

“For a hospital to be run effectively, it has to be run like a business. The CEO of a retailer can become the head of a mine or any other business, as the principle of running a company remains the same: cash flow, managing a budget and an understanding of the balance sheet. In the same way, a hospital also needs a manager that understands these principles.”

 

“However, in addition to having this business acumen, the hospital manager also needs to be given both the budget and the responsibility to run the institution. If he walks down the hospital corridor and sees that a lift is out of order or a boiler is broken, he must be empowered to address these issues immediately and hold his colleagues accountable when repairs have not been done.”

 

Anderson says a hospital manager with control of the budget will also understand the details of the hospital spend and can therefore recognise and root out inefficiencies and corruption. “For example, on a basic level they will know what it costs to feed patients every day and if one hospital is seeing a significant increase in the cost of food, then it is clear that something is remiss.”

 

He says that given the extent of the problems in the state healthcare system, it is crucial that the private and the public sector work together to share best practices. “Many in the private healthcare system would welcome the opportunity to assist in training new hospital managers to work in state hospitals. A greater collaboration between the private and public healthcare systems should also extend to providing part- time posts for medical practitioners and specialists to work in public hospitals.

 

“Most doctors and other practitioners would be very happy to do this. Public hospitals used to act as academic institutions by teaching and training upcoming doctors, which worked extremely well. The idea that most doctors simply want to work in the private sector is not true; the reality is that medicine is a calling and most of those in the industry even now give up their own time for free in order to assist the public sector by treating patients, conducting research and training others.”

 

Anderson says that while resolving the problems in the public healthcare system will take time,  getting in qualified managers who are equipped to run a large organisation and giving them the authority to do their job will go a long way in dealing with the current crisis.

 

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