Feb. 11, 2019

Board of trustees in a hospital as a resource for successful reorganization

It is now possible to establish boards of trustees in hospitals. They can help with hospital development, when the very approach to management of a medical institution and provision of medical services as a whole is changing. So far, however, this resource is not being used often enough. Hospital administrations see such boards as just another regulatory body, business - as browbeating to constant co-financing, and activists - as a new and pointless management superstructure. All these perspectives are erroneous and significantly limit the possibilities of medical institutions.

What’s a board of trustees and what’s it for

A board of trustees is an advisory body. Its purpose is to participate in the development of a hospital’s development strategy and help implement it. Of course, these boards can also attract financial resources, but in the context of the reform, the most important aspect here is the opportunity and willingness of its participants to share their experience — in management, in making business decisions, in team building, marketing, service development, etc. It’s a unique opportunity for hospitals. With a shortage of qualified administrators in the medical sector, one could, with the help of a board of trustees, to take advantage of the experience of business, NGOs and patient associations - that is, of those who already know how to build and develop working systems.

Right now, medical subventions are being gradually replaced by direct payment for services to medical enterprises. While in the past chief hospital administrators used to be responsible for medical issues and only a limited number of managerial decisions, now they must independently organize the work of their entire medical institution, to learn how to find a balance between the quality of medical services and efficient use of resources. It’s quite a task for those that were never taught self-sufficiency and got used to following orders.

Thus, a board of trustees is a resource that community residents to give their respective hospitals - free of charge and to their own ultimate benefit. They can help a yesterday's budget-funded institution become a successful enterprise. Another important benefit granted by boards to trustees is communication with the outside world and the ability to bring in extra resources (not necessarily financial).

What boards of trustees can offer to hospital administrators

Heads of medical institutions should know that it is up to them to establish boards of trustees - they only need to issue an appropriate order. By choosing this path - the path of cooperation with active representatives of the public, administrators will significantly strengthen their own position, which will be of help with future growth.

The fact is that today hospitals are still dependent on the political climate and a number of other local factors, and all chief administrators know this well. So, despite the newly acquired freedom as heads of autonomous medical institutions, they could become even less independent today, since now it’s up to them to handle most of management issues, making them responsible for each of them.

Our team provided legal support for the creation of a board of trustees at one of Rivne hospitals. As early as the first meeting, council members there managed to agree on their vision for the hospital and to plan out the first steps toward this goal. To illustrate, a bank employee shared his experience with queue management, while a representative of a center for the provision of administrative services spoke about setting up children's rooms. They have already agreed on joint implementation of these ideas at the hospital. Thus, the hospital received professional advice from motivated community residents - members of the board of trustees.

Establishing a board of trustees, hospital administrators make their activities more open to the community, as, when the board develops and approves the hospital’s development strategy, it will understand, support and defend it if necessary. This can be the key to successful reorganization.

Boards of trustees have no right of veto or final vote - its decisions are advisory in nature. However, its members can represent the hospital before third parties - donors, patrons and representatives of civil society. It is more of a consultative body, which, if established correctly, is able to support sustainable positive changes in healthcare at the local level.

What could go wrong

In one city, the deputy head of the regional state administration was elected chairman of a board of trustees. Situations like this carry a risk that new formulas proposed by reformers will be filled with old meanings. The board may well become another official body for ambitious local leaders hungry for self-realization. They will be holding official sessions while doctors will be forced to buy them tea, cakes and cognac. It is indeed better to do without such a board of trustees altogether.

Those wishing to create a board of trustees should regard it as a resource that can significantly speed up and improve hospital growth and thus have a positive effect on the health of the public. That’s why the best candidates for the board are those who are truly really interested in improving the quality of medical services in a particular town or village: representatives of business, local authorities, patient associations and other organizations. With the help from the public, business and local authorities, one could get quick results in reforming local self-government as a whole and healthcare in particular.