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BMC Health Services Research

, 14:178

Health systems and services in low and middle income settings

Abstract

BackgroundDecentralization through the establishment of hospital governing boards has been touted as an effective way to improve the quality and efficiency of hospitals in low-income countries. Although several studies have examined the process of decentralization, few have quantitatively assessed the implementation of hospital governing boards and their impact on hospital performance. Therefore, we sought to describe the functioning of governing boards and to determine the association between governing board functioning and hospital performance.

MethodsWe conducted a cross-sectional study with governing board chairpersons to assess board 1 structure, 2 roles and responsibilities and 3 training and orientation practices. Using bivariate analysis and multivariable regression, we examined the association between governing board functioning and hospital performance. Hospital performance indicators: 1 percent of hospital management standards met, measured with the Ethiopian Hospital Reform Implementation Guidelines and 2 patient experience, measured with the Inpatient and Outpatient Assessment of Healthcare surveys.

ResultsA total of 92 boards responded to the survey 96% response rate. The average percentage of EHRIG standards met was 58.1% standard deviation SD 21.7 percentage points, and the mean overall patient experience score was 7.2 SD 2.2. Hospitals with greater hospital management standards met had governing boards that paid members, reviewed performance in several domains quarterly or more frequently, developed new revenue sources, determined services to be outsourced, reviewed patient complaints, and had members with knowledge in business and financial management all P-values < 0.05. Hospitals with more positive patient experience had governing boards that developed new revenue sources, determined services to be outsourced, and reviewed patient complaints all P-values < 0.05.

ConclusionsThese cross-sectional data suggest that strengthening governing boards to perform essential responsibilities may result in improved hospital performance.

KeywordsGovernance Decentralization Ethiopia Healthcare reform AbbreviationsCEOChief Executive Officer

EHRIGEthiopian Hospital Reform Implementation Guideline

FMOHFederal Ministry of Health

GBGoverning Board

RHBRegional Health Bureau

IPAHC-OPAHCInpatient-Outpatient Assessment of Healthcare

BSAQBoard Self Assessment Questionnaire.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-14-178 contains supplementary material, which is available to authorized users.

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Autor: Zahirah McNatt - Jennifer W Thompson - Abraham Mengistu - Dawit Tatek - Erika Linnander - Leulseged Ageze - Ruth Lawson -

Fuente: https://link.springer.com/







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