Hospital Management Practices and Availability of Surgery in Sub-Saharan Africa: A Pilot Study of Three Hospitals
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Abstract
Background
Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are associated with surgical productivity and quality.
Methods
We conducted 54 face-to-face, structured interviews with administrators, clinicians, and technicians at a teaching hospital, district hospital, and religious mission hospital across two countries in sub-Saharan Africa. Questions focused on recommended general management practices within five domains: goal setting, operations management, talent management, quality monitoring, and financial oversight. Records from each interview were analyzed in a qualitative fashion. Each hospital’s management practices were scored according to the degree of implementation of the management practices (1 = none; 3 = some; 5 = systematic).
Results
The mission hospital had the highest number of employees per 100 beds (226), surgeons per operating room (3), and annual number of operations per operating room (1,800). None of the three hospitals had achieved systematic implementation of management practices in all 14 measures. The mission hospital had the highest total management score (44/70 points; average = 3.1 for each of the 14 measures). The teaching and district hospitals had statistically significantly lower management scores (average 1.3 and 1.1, respectively; p < .001).
Conclusions
It is possible to meaningfully assess hospital management practices in low resource settings. We observed substantial variation in implementation of basic management practices at the three hospitals. Future research should focus on whether enhancing management practices can improve surgical capacity and outcomes.
Keywords
Operating Room District Hospital Talent Management Management Domain Mission HospitalNotes
Acknowledgments
The authors are grateful to their collaborators at each institution for their time and assistance in conducting the site visits.
Conflicts of interest
The authors declare no conflicts of interest.
Funding
Funding for this research study was provided by an individual philanthropic donation.
References
- 1.World Health Organization (2008) The Global Burden of Disease: 2004 Update. World Health Organization, GenevaGoogle Scholar
- 2.Debas HT, Gosselin R, McCord C et al (2006) Surgery. In: Jamison DT (ed) Disease control priorities in developing countries, 2nd edn. Oxford University Press, New York, pp 1245–1259Google Scholar
- 3.Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372(9633):139–144PubMedCrossRefGoogle Scholar
- 4.Hodges SC, Mijumbi C, Okello M et al (2007) Anaesthesia services in developing countries: defining the problems. Anaesthesia 62:4–11PubMedCrossRefGoogle Scholar
- 5.Kingham TP, Kamara TB, Cherian MN et al (2009) Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg 144:122–127 discussion 128PubMedCrossRefGoogle Scholar
- 6.Kushner AL, Cherian MN, Noel L et al (2010) Addressing the Millennium Development Goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. Arch Surg 145:154–159PubMedCrossRefGoogle Scholar
- 7.Ozgediz D, Galukande M, Mabweijano J et al (2008) The neglect of the global surgical workforce: experience and evidence from Uganda. World J Surg 32:1208–1215. doi: 10.1007/s00268-008-9473-4 PubMedCrossRefGoogle Scholar
- 8.Walker IA, Merry AF, Wilson IH et al (2009) Global oximetry: an international anaesthesia quality improvement project. Anaesthesia 64:1051–1060PubMedCrossRefGoogle Scholar
- 9.Funk LM, Weiser TG, Berry WR et al (2010) Global operating theatre distribution and pulse oximetry supply: an estimation from reported data. Lancet 376(9746):1055–1061PubMedCrossRefGoogle Scholar
- 10.Bloom N, Van Reenen J (2007) Measuring and explaining management practices across firms and countries. Quart J Econ 122:1351–1408CrossRefGoogle Scholar
- 11.Bloom N, Vann Reenen J (2010) Why do management practices differ across firms and countries? J Econ Perspect 24:203–224CrossRefGoogle Scholar
- 12.Bloom N, Eifert B, Mahajan A et al (2013) Does management matter? Evidence from India. Quart J Econ 128:1–51Google Scholar
- 13.Dorgan S, Layton D, Bloom N et al (2010) Management matters: why good practice really matters. Mckinsey and Company, LondonGoogle Scholar
- 14.Bozic KJ, Maselli J, Pekow PS et al (2010) The influence of procedure volumes and standardization of care on quality and efficiency in total joint replacement surgery. J Bone Joint Surg Am 92:2643–2652PubMedCrossRefGoogle Scholar
- 15.McCulloch P, Kreckler S, New S et al (2010) Effect of a “Lean” intervention to improve safety processes and outcomes on a surgical emergency unit. BMJ 341:c5469PubMedCrossRefGoogle Scholar
- 16.Zwarenstein M, Goldman J, Reeves S (2009) Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2009(3):CD000072Google Scholar
- 17.Bloom N, Mahajan A, McKenzie D et al (2010) Why do firms in developing countries have low productivity? Am Econ Rev 100:619–623CrossRefGoogle Scholar