Abstract
In the past four decades, rapid urbanization and industrialization trends have been experienced globally. This consequently has resulted into changes in the socioeconomic, political, physical, health amongst many other sphere of human life. This implies that in the recent past, there have been massive shifts in the health systems. These changes have had both positive and negative impacts. For instance the infant mortality rate has significantly reduced; if the 1978 trends persisted then trends would have been at 16.7million deaths annually by the year 2006. Though this is not the case; in 2006, the infant mortality rates stood at 9.5million deaths annually. This implies that in that year approximately18229children were saved on a daily basis. Plus, empirical studies allude that the health economy is growing faster than the Gross Domestic Product (GDP). On the other hand, increase in income, populations, climate change, and food insecurity incidences and social insecurity have complicated health problems and thus posed challenges in the management of the health systems.
Some of the challenges faced by the health system today include the following. First, there is the inverse care challenge. In this case, the wealthy few have access to most health care at the expense of the poor majority who need the health care but lack the resources to access it. Also, health care expenditures have resulted to an impoverished population globally. In fact, more than 100million people become poor on a yearly basis as result of health care expenses. Third, there is fragmented health care. In this care, health care providers have formulated specific strategies to target health disorders at the expense of the holistic strategies that will encompass individual and family health in totality. Also, unsafe care is the order of the day. The health care system does not guarantee hygiene and safety standards. To this effect, hospital infections have become more prevalent. Finally, there is the misdirected care burden. Most resources have been directed towards curative measures rather than preventive measures. Thus, as result of all these challenges, hospital administrators are in dire need of strategies that will enable them make the hard decisions in the prevailing health care system conditions. As a result, in the year 2004, the health executives convened a summit in which they discussed how to make tough choices more acceptable. This thesis shall consequently examine their resolutions and go ahead to state how they can be achieved.
1.0 Approaches that Health Executives can use to Make Tough Decisions
According to the Seventh Future Forum of health executives of 2004, a popular policy decision can be defined as that which enjoys public acceptance. On the other hand, an unpopular policy refers to that which does not necessarily meet the public’s anticipations but is essential in improving the quality of the health care system. Given that the essence of an unpopular decision is to improve health service, efforts should be made to ensure absolute public support of the proposed policies. Thus, it is pertinent that the community must understand the necessity of these unpopular decisions for it to accept them. This is the case because, for any decision to be effective policy-wise, goodwill is of the essence especially from all health stakeholders specifically the health care providers and beneficiaries. Some of the approaches that the summit eventually reached at to help health executives make unpopular decisions more acceptable are discussed below. To demonstrate this, the thesis shall have delve into few case studies of health care policies in Europe and critically analyze how the hospital management and the public in general approached the issue at hand.
Some of the considerations that the hospital must consider before making unpopular decisions include the following. First, there is the principle of theory versus practice. The management of the hospitals must understand that making decisions acceptable is a practical rather than a scholastic affair. Second, the hospital should consider the image versus health care dilemma. It should be clear from the word go what the intent of the decision is; to improve health care or is it a majority (political) decision. Third, the hospital executives must specify the target population; whether it is the entire population or a specific percentage of the population. Fourth, the hospital should consider dilemma of making an acceptable versus unpopular decisions. Efforts should be made to make hospital decisions acceptable rather popular. Fifth, the hospital should consider whether the decisions are financially or morally motivated. The public is more likely to accept unpopular decisions based on moral reasons rather than financial ones. Finally, the hospital management must consider the mode of implementation; whether it is consultative or unilateral.
The summit reached a consensus that one of the ways to make unpopular decisions more acceptable by the public is to inform the public the necessity of the decisions reached at by the hospital management. As earlier mentioned, it is clear that the health care environment is changing radically. To keep up, hospital executives must thus work towards ensuring that the standards of the health care system are upheld regardless of the changes the system is under. Thus, hospital management has the responsibility of informing the public that the quality of the health care services form precedence to the making of tough decisions. This approach implies that the decision-makers in hospitals must effectively communicate to the community how the proposed changes would make service delivery better and more efficient. This approach efficiently locks out emotional and political judgment from the debate about whether the proposed decisions are acceptable or not. In the process, hospital executives can win themselves some followers both within the public and hospital ranks. This will prove important in the fact that it is easier for a public member or a physician to convince the community that the hospital decisions are acceptable than it is for the management to do so. Finally, the public is less likely to reject strategies that are directed at improving health care service delivery.
Secondly, it is pertinent that decision makers plan their decisions prior to implementing them. Most unpopular health care decisions are rejected by the public because they are “half-baked.” This is because; the hospital management does not follow the required procedures before formulating and eventually implementing their decisions. Before doing anything, the hospital management must ensure that the proposed plan is part of and parcel of some long term strategy. This ensures that the decisions are in line with other hospital present or future policies. This implies that, proposed decisions must not be in conflict with other hospital interests. The first step in formulating health care policies and decisions is to assess whether there is need for the proposed decisions. The second step is for the hospital management to analyze the need and consider alternative solutions to the problem at hand without compromising health care standards.
After analysis is complete, the hospital executives can then choose the better solution of the proposed alternatives. The next step then is to bring in the stakeholders into the decision making process; specifically the physicians, the relevant authorities and the public in general. This is necessary; it helps if a majority of the stakeholders are aware of the proposed changes in the health care system. Informing stakeholders should be done in a manner that is comprehendible to the different target groups and is backed up by relevant statistics. Thus, using solid facts to back the hospitals’ decisions is one the strategies the management can use to break the public’s opposition toward unpopular decisions. This rigorous process lets the public know that a lot of thought and consideration were put into the decision making process. Thus, clarity, simplicity, transparency and brevity are of the essence. Finally, the hospital management can go ahead and implement the decision. The policies should be reviewed periodically based on the changing health care system.
For the unpopular decisions to be acceptable to the public, it is important that they have the backing of the political class. Hospital executives must acknowledge that public opinion is to a large extent shaped by politicians. This is because politicians are the chosen representatives of the people and thus their stand is widely considered as the people’s. In addition to this, the political class has in place the necessary machinery in place to rally the public behind the hospitals’ unpopular decisions. Thus, the hospital management must make every effort to make sure that politicians accept and support the unpopular decisions and policies. For the health sector to enjoy the support of the political class, they must lobby for it. This means that the strategies the hospitals use to deliver health services must be inline with those of the political class. It is not productive for the hospitals to completely isolate themselves from politics.
It is important to mention that in most countries, the political class controls the public financial reserves. Thus, if the unpopular decisional change is to be made in the public health care system, it is pertinent that the hospital management to liaise with the politicians to ensure that funding of the proposed changes is guaranteed. When dealing with the politicians and the public in general, it must be understood that timing is of the utmost importance. For instance, politicians are more likely to support unpopular hospital policies in the run up to an election year than at the beginning of their terms of service. Thus, for the ruling class it is all about what can earn them the required political mileage. This implies that if the unpopular decision is effected in a period which is inconvenient to the political class, they are bound to mobilize the public against the decisions. For instance, it is illogical for a hospital to effect an unpopular decision in the follow up of a previous failed attempt of the same nature. Generally, hospital executives should take into account prevailing socio-economic, political and health conditions before adapting unpopular decisions in health care delivery.
Another strategy health executives can use in ensuring that unpopular decisions are acceptable is expecting to experience opposition in implementation. They must anticipate wide spread smear campaign for various groups of the society with vested interests. Thus, when communicating the unpopular decision to the public it is necessary that the hospital acknowledges improbability for the decision to be accepted as authentic. This acknowledgement also gives the implementation of the unpopular decisions some flexibility. In addition to this, hospital must anticipate quick shift in public perceptions. This implies a previously acceptable unpopular hospital decision can be unacceptable overnight without any prior warning and the converse also holds. These unprecedented dynamics must be accommodated in the decision making process. This alludes that whenever hospital executives are making any unpopular decisions, they must be ready for crisis management. Stakeholders in the health care provision field will definitely react differently towards the unpopular decision. Thus, the management must be ready to accommodate all this diverse reactions. This implies that the management must be fearless in order to surmount any challenges that the implementation of the decisions shall present them. It is pointless to implement a policy that the management is sure to abandon when faced with slight opposition.
Also, whenever making unpopular decisions the hospital management must guarantee the support of physicians before even trying to seek public support. This is because in their line of duty, medical practitioners have had experience in delivering uncomfortable news to the public. In addition, just as the public values the political class, they trust their physicians even more. Plus, in the eventuality that effecting of the unpopular decisions will be riddled by technical issues, the hospital will rely on health professionals to iron the issues out. In most countries, the law upholds the assessment of physicians in health matters. This implies that their assessment is supreme to any other vested interests. Finally, the executives can also use successful models within or without the country to convince the public of the effectiveness of unpopular hospital decisions. Thus, these decisions must be based on some successful model elsewhere for them to acceptable to the public. If disparities exist between the model and the preferred decision, it is the prerogative of the hospital management to clarify why that is so.
2.0 Case Studies
For this approaches to make more sense, the thesis shall now examine a few case studies in Europe to demonstrate how the proposed strategies would have been or were effective. In most Western European countries, it is a common healthcare strategy to reduce hospital beds and close some hospitals. This strategy is targeted at minimizing unnecessary hospital treatments, emphasizing primary health and outpatient care. Other motivations for adopting this strategy are to act in response to the ever dynamic health care environment that needs emphasis on specialization and improving efficiency of the health care sector. Another factor in play is the fact that the dynamic economic condition dictates that health care services be cost effective without compromising the quality. Thus, the case studies below shall examine how the public reacts towards the reduction in hospital beds and hospitals in general. These case studies also demonstrate how best the aforementioned strategies can be used to make unpopular decisions at King Abdulaziz Hospital National Guard, Riyadh, Saudi Arabia.
In Austria, specifically Vienna, hospital executives were faced with a dilemma where by there were three small paedtriatic hospitals each in need of similar equipment to that required by one large hospital. Thus, the decision was to merge the three into one large hospital and utilize the resources from the three to furnish the larger hospital. Between the1994 and 2003, several small hospitals were merged therefore leading to a reduction of the bed capacity in the hospitals by 6,000. This was done in order to come up with sustainable and well equipped health facilities. This was met with resistance on several fronts because there was a loss of jobs in the process of executing the plan. The plan was not synchronized with the plans that each region had in terms of their finances. In order to avoid the recurrence of such problems in future, efforts ought to be made to communicate effectively with the regional planners. A time should be set prior to execution of such a plan in order to consult and communicate with the respective shareholders.
In the Netherlands, the law allows for the closure of hospitals in instances where the management deems it fit. However only in rare instances has this been executed. In most cases, older health facilities have been restructured and equipped with modern equipment. In addition to this, smaller hospitals could also be merged into larger ones. The implementation of such a plan however results in loss of jobs if those involved are not given adequate time to prepare. The politicians always voice their concerns when such occurrences take place as a way to win the electorate. The merging of hospitals could also present a challenge to the access of health facilities. The plan to structure should be executed after dialogue with all who are affected. Compensation could be offered to those who loose their jobs in the process. When merging hospitals, a central location that can easily be accessed by all those who are within a given region ought to be considered.
3.0 Conclusion
The health care system has a pivotal role in the society. Thus, a good number of strategies should be dedicated towards ensuring that the provision of health care service is done efficiently. To this effect, the beneficiaries, medical practioners and politicians should be in a position to accept both popular and unpopular decisions that have been made by the hospital management. However, for this to be possible the hospital executives must formulate approaches to convince all other stake holders that their unpopular decisions serve the interests of the health care system.
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Orme, J., Powell, J., Taylor, P., & Grey, M. (2007). Public Health for the 21st Century: New Perspectives on Policy,Participation and Practice (Second Edition). Berkshire: Open University Press.
