IHF / World Health Organization (WHO) collaboration on Hospital Portfolio Review

Following the publication of the 2008 World Health Report (WHR) “PHC Now More Than Ever”, the World Health Organization (WHO) has initiated a stream of work on hospitals in order to better engage them in support of Primary Health Care (PHC). The first initiative involved a review of the role of district hospitals and the level of progress made over the last decade. A workshop, organized in Rio de Janeiro, Brazil in November 2009, in conjunction with the IHF 36th World Hospital Congress, created the opportunity to take stock of the current situation across the globe. The major conclusion from the workshop was that over the past decade hospitals have attracted very little interest in the field of research, and that policy makers have made limited progress in the mobilization of the hospital sector. At the Brazil workshop, the International Hospital Federation (IHF) presented a framework, acknowledged as having appropriately captured the role and functions of hospitals at district level as well as for any other level.  The framework highlights the diversity of activities hospitals undertake and as a result calls for further work to determine ways in which a consistent approach could be found in the governance of hospitals. In order to realize this objective, a further review was deemed necessary of the strategy by which WHO, through its various units in their support of different programs, may engage the hospital sector.  The objective of the reviewing being to provide clearer understanding of the resources at the disposal of WHO to assume its role in global governance of hospitals and effectively assist in achieving the PHC renewal strategy.  IHF was commissioned to conduct the review in order to ensure impartiality and objectivity.

REPORT: KEY FINDINGS AND RECOMMENDATIONS

The draft report provides key findings of the overall portfolio review of activities and the major challenges facing hospitals and provides various recommendations on the way forward.  A unique generic hospital model developed by IHF to describe the internal and external forces that shape the nature and level of performance of hospitals, is featured in the report.  The model highlights the three levels of intervention: policy and governance, market forces and population needs and demands, whilst emphasizing the role that adequate management and leadership plays in ensuring good performance by the hospital.  Details of the key findings on the major challenges facing hospitals featured in the Report will be made available on the IHF website in the coming weeks.

Portfolio Review of the World Health Organization

Key findings:

Issues pertaining to hospitals  are approached by different WHO departments. The portfolio review of activities highlights several gaps in how WHO deals with the hospital sector, including:

- The focus on PHC leaves little space for the hospital sector

- The vertical approach and the scattering of efforts mean that there is a lack of coordination and synergy

- Most guidance produced is of a technical nature and is consequently rarely focused on decision making processes

Major Challenges Facing Hospitals

Key findings:

Although the hospital sector is organized differently from one country to another, similar challenges can be found all around the world. Using the generic hospital model we can present the challenges related to:

- The hospital environment: good governance is essential for improving hospital performance and efficiency. In the context of globalization and limited resources, where restricting hospital costs is of central importance, most health reforms include regulation, financing and planning.

 - Hospital inputs: the exposure of hospitals to market forces influences their performance because market forces have a direct impact on hospitals inputs, i.e. information systems, human resources, drugs and consumables, services and health technology.

- Hospital operations: as for the corporate sector, the operation of hospitals requires good governance and strong management and leadership capacities, in order to reach high level performance and quality.

- Hospital functions and output: service delivery is evolving according to new global trends: the aging population, epidemiological patterns, evolution of the social determinants on health and new technologies for diagnosis and treatment.

Possible Roles for the World Health Organization

Key recommendations:

-Collaborate on a global definition of hospitals

- Develop a holistic approach of delivering care to the population by including a sharper focus on hospitals

- Combine both a policy and a normative technical role. For example, by adopting the generic hospital model and developing an agenda that includes all hospital roles and functions

- Develop a full risk management approach, including the use of the Hospital Safety program

- Become involved, in coordination with other partners, in the main issues facing hospitals, such as quality of care and safety, medical tourism, etc.

The Way Forward Using International Expertise

Key recommendations:

There is a need to expose WHO’s in-house thinking on hospitals to external partners, especially to stakeholders to whom WHO is accountable. It is also necessary to include health professionals in these discussions, for they have a sense of their needs and the issues they are facing. Such a move will require structure and guidance. Furthermore, an important effort needs to be undertaken to collect and disseminate standardized data on the activities of hospitals throughout the world. 

The Generic Hospital Model

Key point:

IHF developed a model that describes the hospital as a production entity. In this model, internal and external forces shape the nature and level of performance.  Hospital functions are also paid special attention. It highlights three levels of interventions: policy and governance, market forces and population needs and demands. The model also emphasizes that adequate management and leadership will ensure good performance for a hospital.

The model will be used as a framework to describe various challenges facing hospitals, including those:

- Related to the hospital environment

- Related to hospital inputs

- Related to hospital operations

- Related to hospital functions and output