Improving hospital management structures to improve the quality of health service delivery.
In any health system, hospitals are increasingly complex and costly organisations. Effective and efficient management of hospitals pose huge challenges in both developed and developing countries.
However, the positive impact of an effective Hospital Management Committee and Hospital Advisory Board on hospital operations is clearly shown at Tonj Civil Hospital in South Sudan where Comitato Collaborazione Medica is implementing the Health Pooled Fund (HPF) programme. The Hospital Advisory Board is made up of representatives of the community and the senior managers of the hospital to ensure community inputs are built into the planning and hospital management.
Tonj Civil Hospital was previously managed solely by the hospital director with assistance from an administrator and a matron. There were neither management committees nor an advisory board to guide decisions. Coordination between the Tonj South County Health Department which runs primary health care services and the hospital which provides secondary health care was challenging as the two rarely met and there were no clear linkages in place. The Tonj Civil Hospital plays a vital role in support of Primary Health Care services in its catchment area. Hospital director, Dr Mathiang Agany said the hospital previously lacked the staff capacity to discuss management issues and there was insufficient information about the Terms of Reference for a Hospital Advisory Board to support its establishment.
Effective health service delivery means integrated Primary Health Care services providing a continuum of care with effective linkages on all levels. Improving the quality of care at hospitals was therefore important so that the expectant communities could receive satisfactory care. HPF therefore started by strengthening the management of these hospitals in order to transform them from institutions in which communities had little confidence in to those they would look forward to visiting because of improved cleanliness, better motivated staff and better care of their ailments.
After the HPF interventions at community level and Primary Health Care Centres and Units began to bear fruit, it became essential that the hospitals responded to the demand created from referrals of patients from the primary level of care and supported health workers at primary level.
HPF assessed 19 hospitals supported by the programme in South Sudan to determine the existence and functionality of hospital management committees and advisory boards. HPF then produced comprehensive guidelines and procedures for establishing management committees and advisory boards and conducting effective meetings, which were distributed to all 19 hospitals. HPF also held a series of train-the-trainer workshops on hospital administration and management in collaboration with the World Health Organisation (WHO).
Tonj Hospital staff, County Health Department and community members agree that the management of the hospital has improved significantly under HPF. The establishment of the Hospital Management Committee and Advisory Board has stimulated better decision-making, team work and relationships between the hospital administration, implementing partners and stakeholders. The resultant boost in service quality has increased community confidence and use of the facility.
The expanded Hospital Management Committee composed of the hospital director, Comitato Collaborazione Medica medical coordinator, hospital matron, finance and administration officer and all department heads have helped to improve important linkages for the smooth running of the hospital by meeting weekly to guide decision-making and improve service quality. Hospital Management Committee decisions have contributed to shorter waiting times in the Out Patient Department thanks to improved patient flow management and better patient records and data keeping procedures. Day and night schedules for nurses and doctors have been created and directions given to staff to maximise the use of supplies and drugs and ensure proper infection control procedures are being followed.
The Hospital Management Committee has selected subcommittees to monitor the hospital activities and inform its planning and actions. The sub-committees oversee ethics and disciplinary action, infection control, supplies and infrastructure, finance, quality of care, clinical management, and perinatal mortality reviews. The Hospital Advisory Board represents the interests of community and meets quarterly to review hospital operations and provides feedback to the administration to help improve services. The diverse membership seeks to ensure the views of women, religious and youth groups, local and state government and the County Health Department are heard by the Hospital Management Committee.
At Tonj Hospital the Hospital Advisory Board proposed a revision of the cost sharing scheme for hospital services. It was also involved in revising the ambulance services standard operating procedures and costs to patients. The subsequent lower costs have made all services more affordable for the community. Out Patient Department consultations and the number of women attending for both safe motherhood services and obstetric and gynaecological emergencies has increased as a result.
Hospital advisory board members say that the positive influence of the Hospital Advisory Board is evident in the improved relationship between the hospital and the County Health Department and the community’s positive response to the revised cost sharing arrangements. Community members agree that the service quality has improved considerably now the management committees and advisory board are in place and fully operational. By improving this quality of care, HPF is able to demonstrate improved client and patient satisfaction and increased use of health care services.
By 2030, SDG 3 hopes to ensure healthy lives and promote well-being for all ages, to achieve this, the objective of Universal Health Coverage (UHC) must be that all people have access to the essential health services they need, including financial risk protection and access to a quality health workforce. HPF is committed to achieving UHC in South Sudan as the support to hospital management committees and advisory boards demonstrates, by improving health services and implementing financial risk protection, HPF are supporting resilient health systems and vulnerable communities.
Find further information about HPI’s health systems strengthening support to the Health Pooled Fund, South Sudan and stories from the field.
An original version of this blog was posted on the HPF South Sudan website and can be found here.