Public hospital management in times of crisis: Lessons learned from Cienfuegos, Cuba (1996-2008)
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.
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.
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.:
- AfDB AfDB, . "AfDB Group Annual Report 2008," Annual Report, African Development Bank, number 64 edited by Koua Louis Kouakou.
- 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.
- 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.
- 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.
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: (Zhang, Lei)or ()
If references are entirely missing, you can add them using this form.