IDEAS home Printed from
MyIDEAS: Log in (now much improved!) to save this article

Public hospital management in times of crisis: Lessons learned from Cienfuegos, Cuba (1996-2008)

Listed author(s):
  • De Vos, Pol
  • Orduñez-García, Pedro
  • Santos-Peña, Moisés
  • Van der Stuyft, Patrick
Registered author(s):

    Cuba's public health system is well known for its integrated first line services based on family medicine. Less publicized is the country's experience in public hospital management. After a harsh economic crisis in the first half of the 1990s had brought the Cienfuegos hospital near to collapse, from 1996 onwards the hospital management team took advantage of the incipient economic recovery to launch an ambitious recovery process. This article reconstructs this endeavor, based on annual hospital reports, scientific publications by the hospital staff, and interviews with key decision-makers. First the endless waiting list for elective surgery was tackled through a more efficient use of the surgery department, and an increase of ambulatory surgery. Next, overall hospital efficiency was improved in the aim to drastically reduce the average length of stay, reaching a decrease from an average stay of 12 days to a little more than 6 days in 1999. Also the emergency department was reorganized, setting up a triage system based on a color code, linked to specific emergency protocols. Attention for improving the clinical efficiency for AMI and stroke coincided with a drop in their intrahospital lethality. Clinical guidelines for the most important diagnoses were collectively developed, adapting international evidence to the local setting. An individual and collective performance evaluation system was elaborated in a participatory way, and further evolved into a 'total quality management' process. This experience of Cienfuegos hospital provides an interesting example on how a public hospital - embedded in a well developed national public health system - can be effective and efficient, even in circumstances of limited resources.

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.

    Article provided by Elsevier in its journal Health Policy.

    Volume (Year): 96 (2010)
    Issue (Month): 1 (June)
    Pages: 64-71

    in new window

    Handle: RePEc:eee:hepoli:v:96:y:2010:i:1:p:64-71
    Contact details of provider: Web page:

    References listed on IDEAS
    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:

    in new window

    1. De Vos, Pol & Murlá, Pedro & Rodriguez, Armando & Bonet, Mariano & Màs, Pedro & Van der Stuyft, Patrick, 2005. "Shifting the demand for emergency care in Cuba's health system," Social Science & Medicine, Elsevier, vol. 60(3), pages 609-616, February.
    2. Iriart, Celia & Elías Merhy, Emerson & Waitzkin, Howard, 2001. "Managed care in Latin America: the new common sense in health policy reform," Social Science & Medicine, Elsevier, vol. 52(8), pages 1243-1253, April.
    3. De Vos, Pol & Vanlerberghe, Veerle & Rodriguez, Armando & Garcia, Rene & Bonet, Mariano & Van der Stuyft, Patrick, 2008. "Uses of first line emergency services in Cuba," Health Policy, Elsevier, vol. 85(1), pages 94-104, January.
    4. AfDB AfDB, . "AfDB Group Annual Report 2008," Annual Report, African Development Bank, number 64 edited by Koua Louis Kouakou.
    Full references (including those not matched with items on IDEAS)

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:96:y:2010:i:1:p:64-71. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu)

    or ()

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.