Hospital Foundation: A SWOT Analysis
ABSTRACT
The reform of Portuguese public hospitals can be described as an evolution by “waves”. A first “wave” took place in 2002, when 34 public hospitals were transformed into State-owned hospital enterprises (SA hospitals). Subsequently, in January 2006, the SA hospitals and some of the traditional public administration hospitals (SPA hospitals) were changed into public business enterprises (EPE hospitals). That was the second “wave” that is the stage we are at pre- sent. A possible third “wave” can be related with the possibility of conversion of the EPE hospitals into State Hospital Foundations (SHF). This paper tries to identify if this new management model has more capacity to influence positively values such as efficiency, equity, quality, governance, empowerment and accountability than the previous existing model. For this purpose it was developed a strategic analysis including an evaluation of some internationals experi- ences, and also a SWOT analysis was performed. The authors conclude that the introduction of SHF model is a very plausible alternative. The model of governance can make the difference and promote its implementation. Due to the participative management model, the process of accountability can be more “visible” and the regulatory process of this management model seems to be more effective.
The reform of Portuguese public hospitals can be described as an evolution by “waves”. A first “wave” took place in 2002, when 34 public hospitals were transformed into State-owned hospital enterprises (SA hospitals). Subsequently, in January 2006, the SA hospitals and some of the traditional public administration hospitals (SPA hospitals) were changed into public business enterprises (EPE hospitals). That was the second “wave” that is the stage we are at pre- sent. A possible third “wave” can be related with the possibility of conversion of the EPE hospitals into State Hospital Foundations (SHF). This paper tries to identify if this new management model has more capacity to influence positively values such as efficiency, equity, quality, governance, empowerment and accountability than the previous existing model. For this purpose it was developed a strategic analysis including an evaluation of some internationals experi- ences, and also a SWOT analysis was performed. The authors conclude that the introduction of SHF model is a very plausible alternative. The model of governance can make the difference and promote its implementation. Due to the participative management model, the process of accountability can be more “visible” and the regulatory process of this management model seems to be more effective.
KEYWORDS
Corporatisation, Hospital Foundation, New Public Management, SWOT Analysis, Portugal, United Kingdom
Corporatisation, Hospital Foundation, New Public Management, SWOT Analysis, Portugal, United Kingdom
Cite this paper
nullG. Rego and R. Nunes, "Hospital Foundation: A SWOT Analysis," iBusiness, Vol. 2 No. 3, 2010, pp. 210-217. doi: 10.4236/ib.2010.23026.
nullG. Rego and R. Nunes, "Hospital Foundation: A SWOT Analysis," iBusiness, Vol. 2 No. 3, 2010, pp. 210-217. doi: 10.4236/ib.2010.23026.
References
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[1] G. Majone, “The Rise of the Regulatory State in Europe,” West European Politics, Vol. 17, No. 3, 1994, pp. 77-101. [2] G. Majone, “From the Positive to the Regulatory State: Causes and Consequences of Change in the Mode of Governance,” Journal of Public Policies, Vol. 17, No. 2, 1997, pp. 139-167. [3] P. Rosanvallon, “La Crisis del Estado Providencia,” Ma- drid, Editorial Civitas, 1995. [4] G. Boyne, C. Farrell, J. Law, et al., “Evaluating Public Management Reforms: Principles and Practice,” Manag- ing the Public Services Series, Open University Press, Philadelphia, 2003. [5] P. Noordhoek and R. Saner, “Beyond New Public Man- agement: Answering the Claims of both Politics and So- ciety,” Public Organisation Review: A Global Journal, Vol. 5, No. 3, 2005, pp. 35-53. [6] R. Meyer, “Changing Institutional Logics and Executive Identities: A Managerial Challenge to Public Administra- tion in Austria,” American Behavioral Scientist, Vol. 49, No. 7, 2006, pp. 1000-1014. [7] O. Williamson, “Markets and Hierarchies,” The Free Press, New York, 1975. [8] K. Staley, “Voices, Values and Health: Involving the Public in Moral Decisions,” King’s Fund Publishing, London, 2001. [9] A. Sindane, “Public Administration Versus Public Man- agement: Parallels, Divergences, Convergences and Who Benefits?” International Review of Administrative Sci- ences, Vol. 70, No. 4, 2004, pp. 665-672. [10] A. Arndt and B. Bigelow, “Toward the Creation of an Institutional Logic for the Management of Hospitals: Ef- ficiency in the Early Nineteen Hundreds,” Medical Care Research and Review, Vol. 63, No. 3, 2006, pp. 369-394. [11] OCDE, “Future Budget Pressures Arising from Spending on Health and Long-Term Care,” Organisation for Eco- nomic Co-Operation and Development, Paris, 2006. [12] D. Cutler and J. Horwitz, “Converting Hospitals from not-for-Profit to for-Profit Status: Why and What Ef- fects?” In: D. Cutler, Ed., The Changing Hospital Indus- try. Comparing not-for-Profit and for-Profit Institutions, National Bureau of Economic Research, The University of Chicago Press, Chicago, 2000. [13] D. Staiger and M. McClellan, “Comparing Hospital Qual- ity at for-Profit and not-for-Profit Hospitals,” In: D. Cut- ler, Ed., The Changing Hospital Industry. Comparing not-for-Profit and for-Profit Institutions, National Bureau of Economic Research, The University of Chicago Press, Chicago, 2000. [14] A. Cadbury, “Corporate Governance and Chairmanship: A Personal View,” Oxford University Press, Oxford, 2002. [15] B. Coyle, “Corporate Governance,” ICSA Professional Development 2003-4, ICSA Publishing Ltd, London, 2003. [16] O. Hughes, “Public Management & Administration: An Introduction,” 2nd Edition, Palgrave, New York, 1998. [17] J. Sussex, “The Economics of the Private Finance Initia- tive in the NHS,” Office of Health Economics, London, 2001. [18] G. Rego, R. Nunes and J. Costa, “The Challenge of Cor- poratisation: The Experience of Portuguese Public Hos- pitals,” The European Journal of Health Economics, Vol. 1, No. 4, 2010, pp. 367-381. [19] G. Rego, C. Nunes, H. Melo and R. Nunes, “Distributive Justice and the Introduction of Generic Medicines,” Health Care Analysis, Vol. 10, No. 2, 2002, pp. 221-229. [20] M. Fahy, J. Roche and A. Weiner, “Beyond Governance. Creating Corporate Value through Performance, Confor- mance and Responsibility,” John Wiley & Sons Ltd., Chichester, 2005. [21] R. Nunes, G. Rego and C. Brand?o, “The Rise of Inde- pendent Regulation in Health Care,” Health Care Analy- sis, Vol. 15, No. 3, 2007, pp. 169-177. [22] R. Nunes, G. Rego and C. Brand?o, “Healthcare Regulation as a Tool for Public Accountability,” Medi- cine, Healthcare and Philosophy, Vol. 12, No. 3, 2009, pp. 257-264. [23] P. Khaleghian and M. Gupta, “Public Management and the Essential Public Health Functions,” World Develop- ment, Vol. 33, No. 7, 2005, pp. 1083-1099. [24] GASB – Governmental Accounting Standards Board, “Concepts Statement No. 1. Objectives of Financial Re- porting,” GABS, Stanford, 1987, In: S. Ellwood and S. Newbury, Eds., “A Bridge too Far: A Common Con- ceptual Framework for Commercial and Public Benefits Entities,” Accounting and Business Research, Vol. 36, No. 1, pp. 19-32. [25] Monitor, Independent Regulator of NHS Foundation Trusts, NHS Foundation Trusts Model Core Constitution, London, September 2008. [26] Monitor, Independent Regulator of NHS Foundation Trusts, Prudential Borrowing Code (PBC) for NHS Foundation Trusts, London, March 2005. [27] R. Ellis and T. McGuire, “Hospital Response to Prospective Payment: Moral Hazard, Selection and Practice-Style Effects,” Journal of Health Economics, Vol. 15, No. 6, 1996, pp. 257-277. [28] D. Hodgkin and T. McGuire, “Payments Levels and Hos- pital Response to Prospective Payment,” Journal of Health Economics, Vol. 13, No. 1, 1994, pp. 1-29. [29] Department of Health, “A Short Guide to NHS Founda- tion Trusts,” London, November 2005. [30] Healthcare Commission, The Healthcare Commission’s Review of NHS Foundation Trusts, Healthcare Commis- sion, London, 2005. [31] P. Day and R. Klein, “Governance of Foundation Trusts: Dilemmas of Diversity,” The Nuffield Trust, London, 2005. [32] R. Lewis, “Governing Foundation Trusts: A New Era for Public Accountability,” King’s Fund, London, 2005. [33] C. Ham and P. Hunt, “Membership Governance in NHS Foundation Trusts: A Review for the Department of Health,” University of Birmingham, MUTUO, London, March 2008. [34] M. Lowe-Lauri, “Foundation Trusts Governors can and should Exercise their Influence in the Wider Community to Benefit Services Users,” Health Service Journal, Vol. 13, March 2008. [35] R. Lewis and L. Hinton, “Citizen and Staff Involvement in Health Service Decision Making: Have National Health Service Foundation Trusts in England given Stakeholders a Louder Voice?” Journal of Health Services Research and Policy, Vol. 13, No. 1, 2008, pp. 19-25. [36] C. Piggot, “Business Planning for Healthcare Manage- ment,” 2nd Edition, Open University Press, London, 2000. [37] G. Johnson and S. Kevan, “Exploring Corporate Strat- egy,” Prentice Hall, Cambridge, 1996. [38] S. Wilmot, “Foundation Trusts and the Problem of Le- gitimacy,” Health Care Analysis, Vol. 12, No. 2, 2004, pp. 157-169.