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Public hospital management in times of crisis: lessons learned from Cienfuegos, Cuba (1996-2008) (Reprinted from Health Policy, 2010)

(2010) MEDICC REVIEW. 12(2). p.37-43
Author
Organization
Abstract
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.
Keywords
health services organization, public health system, SYSTEM, Hospital management, Cuba, strategic planning, CARE, REFORM, BLOOD, LATIN-AMERICA

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Chicago
De Vos, Pol, Pedro Ordúñez-García, Moisés Santos-Peña, and Patrick Van Der Stuyft. 2010. “Public Hospital Management in Times of Crisis: Lessons Learned from Cienfuegos, Cuba (1996-2008) (Reprinted from Health Policy, 2010).” Medicc Review.
APA
De Vos, Pol, Ordúñez-García, P., Santos-Peña, M., & Van Der Stuyft, P. (2010). Public hospital management in times of crisis: lessons learned from Cienfuegos, Cuba (1996-2008) (Reprinted from Health Policy, 2010). MEDICC REVIEW.
Vancouver
1.
De Vos P, Ordúñez-García P, Santos-Peña M, Van Der Stuyft P. Public hospital management in times of crisis: lessons learned from Cienfuegos, Cuba (1996-2008) (Reprinted from Health Policy, 2010). MEDICC REVIEW. 2010. p. 37–43.
MLA
De Vos, Pol et al. “Public Hospital Management in Times of Crisis: Lessons Learned from Cienfuegos, Cuba (1996-2008) (Reprinted from Health Policy, 2010).” MEDICC REVIEW 2010 : 37–43. Print.
@misc{1113836,
  abstract     = {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.},
  author       = {De Vos, Pol and Ordúñez-García, Pedro and Santos-Peña, Moisés and Van Der Stuyft, Patrick},
  issn         = {1555-7960},
  keywords     = {health services organization,public health system,SYSTEM,Hospital management,Cuba,strategic planning,CARE,REFORM,BLOOD,LATIN-AMERICA},
  language     = {eng},
  number       = {2},
  pages        = {37--43},
  series       = {MEDICC REVIEW},
  title        = {Public hospital management in times of crisis: lessons learned from Cienfuegos, Cuba (1996-2008) (Reprinted from Health Policy, 2010)},
  url          = {http://mediccreview.medicc.org/index.php?issue=12&id=144&a=vahtml},
  volume       = {12},
  year         = {2010},
}

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