Institute of Tropical Medicine Antwerp
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Public hospital management in times of crisis: lessons learned from Cienfuegos, Cuba (1996-2008)

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dc.contributor.author De Vos, P.
dc.contributor.author Orduñez-García, P.
dc.contributor.author Santos-Pena, M.
dc.contributor.author Van der Stuyft, P.
dc.date.accessioned 2010-06-15T13:32:09Z
dc.date.available 2010-06-15T13:32:09Z
dc.date.issued 2010
dc.identifier.issn 1527-3172
dc.identifier.other ITG-H1A
dc.identifier.other ITG-HLA
dc.identifier.other HEALTH
dc.identifier.other U-EPID
dc.identifier.other Abstract
dc.identifier.other UPD22
dc.identifier.uri http://hdl.handle.net/10390/6181
dc.description.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 en
dc.language English en
dc.subject Public health en
dc.subject Health systems en
dc.subject Hospitals en
dc.subject Management en
dc.subject Planning en
dc.subject Health services en
dc.subject Organization en
dc.subject Efficiency en
dc.subject Emergency medical services en
dc.subject Public services en
dc.subject Performance en
dc.subject Cuba en
dc.subject Caribbean en
dc.subject America, Latin en
dc.title Public hospital management in times of crisis: lessons learned from Cienfuegos, Cuba (1996-2008) en
dc.type Article en
dc.citation.issue 2 en
dc.citation.jtitle MEDICC Review en
dc.citation.volume 12 en
dc.citation.pages 37-43 en
dc.citation.jabbreviation MEDICC Rev en


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